{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARTHUR  W CLARKE","gend":0,"add":"2586 JUDES FERRY RD","city":"POWHATAN","state":"VA","zip":"23139-9998","dob":"1938-07-23","age":"","mstatus":"","insh":"900042035*01","cliId":"8ER9PR1XT36","pno":"804\/794-6587","cno":"804\/794-6587","email":"","ename":"","eno":"","pphy":"BAIN, FRANCIS N MD","ppno":"804\/556-6101","pcpadd":"2948 RIVER RD WEST","pcpcity":"GOOCHLAND","pcpstate":"VA","pcpzip":23063,"pcpcounty":"","pcpid":105626,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/556-6468","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R94.5","R20.8","I10.","R73.01","C61.","K21.9","Z79.899","H92.09","H90.3","M10.9","E87.5","E78.00","R51.9","Z85.46","N18.4","R80.9","R15.9"],"date":["2021-03-23","2021-03-18","2021-08-03","2021-03-08","2021-03-08","2021-07-15","2021-03-08","2021-06-04","2021-06-04","2021-08-03","2021-07-20","2021-07-15","2021-07-15","2021-07-15","2021-08-03","2021-08-03","2021-07-15"],"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":[["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","228202950","ALPRAZOLAM","TAB 0.5MG","60","Select","Select",""],["","70710121005","ALLOPURINOL","TAB 300MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE DR ","","30","Select","Select",""],["","65862057490","MONTELUKAST SODIUM ","","30","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","","30","Select","Select",""],["","59651000305","OMEPRAZOLE DR","","90","Select","Select",""],["","59746038506","TERAZOSIN HCL","","90","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","45802065078","LORATADINE","10MG","90","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","21","Select","Select",""],["","65162084009","VALSARTAN","320MG","-90","Select","Select",""],["","50228014610","HYDROCHLOROTHIAZIDE","12.5MG","90","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}