{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAT PAL","gend":0,"add":"1921 ROBERT HALL BLVD APT 3113","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1944-08-20","age":"","mstatus":"","insh":"900041819*01","cliId":"5NG9QD2RW41","pno":"757\/242-8472","cno":"757\/242-8472","email":"","ename":"","eno":"","pphy":"PHYSICIAN, MR PRIMARY CARE MD","ppno":"","pcpadd":"4417 CORPORATION LANE","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"799MR","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I65.22","E11.9","I10.","E78.5","R42.","R94.31","E11.65"],"date":["2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-03-18"],"priorHcc":["","","","","","",""]}},{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","08317780050","RELION ","GLUCOSE","300","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","90","Select","Select",""],["","13107000130","MIRTAZAPINE ","7.5MG","90","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","SENSOR","2","Select","Select",""],["","00169183711","NOVOLIN ","70\/30","30","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","READER","1","Select","Select",""],["","68645055554","LISINOPRIL ","40MG","90","Select","Select",""],["","57237010099","METOPROL ","25MG","90","Select","Select",""],["","68645051054","HYDROCHLOROT ","25MG","90","Select","Select",""],["","69315012710","FOLIC ","1000MCG","90","Select","Select",""],["","55111064530","OMEPRAZOLE ","40MG","30","Select","Select",""],["","68645058459","METFORMIN ","1000MG","180","Select","Select",""],["","42806054701","VITAMIN ","1.25MG","8","Select","Select",""],["","16729048601","METHOTREXATE ","2.5MG","84","Select","Select",""],["","00093505898","ATORVASTATIN ","40MG","90","Select","Select",""],["","68645057454","GLIPIZIDE ","5MG","90","Select","Select",""],["","000169183702","NOVOLIN70\/30 ","RELION","90","Select","Select",""],["","59746017210","PREDNISONE ","5MG","90","Select","Select",""],["","08317780050","","GLUCOSE","300","Select","Select",""],["","08317780050","RELION","GLUCOSE","300","Select","Select",""],["","68180072103","AMLODIPINE","10MG","90","Select","Select",""],["","55111064530","OMEPRAZOLE","40MG","30","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","SENSOR","2","Select","Select",""],["","57599000200","FREESTYLE MIS READER","READER","1","Select","Select",""],["","68645055554","LISINOPRIL","40MG","90","Select","Select",""],["","00169183711","NOVOLIN","70\/30","30","Select","Select",""],["","13107000130","MIRTAZAPINE","7.5MG","90","Select","Select",""],["","68645058459","METFORMIN","1000MG","180","Select","Select",""],["","57237010099","METOPROL","25MG","90","Select","Select",""],["","69315012710","FOLIC","1000MCG","90","Select","Select",""],["","68645057454","GLIPIZIDE","5MG","90","Select","Select",""],["","00093505898","ATORVASTATIN","40MG","90","Select","Select",""],["","51079067005","METHOTREXATE","2.5MG","-84","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","90","Select","Select",""],["","00169183702","NOVOLIN70\/30","RELION","90","Select","Select",""],["","59746017210","PREDNISONE","5MG","90","Select","Select",""],["","42806054701","VITAMIN","1.25MG","8","Select","Select",""],["","42799011901","BUMETANIDE ","TAB 0.5MG","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":""}]}]}