{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CONNIE   H NAPIER","gend":1,"add":"217 PINE VALLEY ROAD","city":"TAPPAHANNOCK","state":"VA","zip":"22560-9998","dob":"1947-11-28","age":"","mstatus":"","insh":"900042391*01","cliId":"7AD0E00YQ33","pno":"804\/445-5234","cno":"804\/445-5234","email":"","ename":"","eno":"","pphy":"WALKER, ANDREW F MD","ppno":"804\/493-9999","pcpadd":"18849 KINGS HGHWY","pcpcity":"MONTROSS","pcpstate":"VA","pcpzip":22520,"pcpcounty":"","pcpid":109562,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","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":["G47.33","R94.5","D69.6","R74.9","E11.69","I10.","E78.5","L03.031","E11.42","L03.032","G62.9","M79.671","Z91.81","F01.50","M79.672","G47.52"],"date":["2021-09-21","2021-05-03","2021-05-03","2021-05-03","2021-04-23","2021-04-23","2021-04-23","2021-06-09","2021-06-09","2021-10-25","2021-01-20","2021-01-20","2021-01-20","2021-01-11","2021-10-25","2021-09-21"],"priorHcc":[null,"","","","","","","","",null,"","","","",null,null]}},{"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":[["","00003089421","ELIQUIS ","5MG","180","Select","Select",""],["","68382009810","PAROXETINE ","20MG","90","Select","Select",""],["","65862014305","CARVEDILOL ","6.25MG","180","Select","Select",""],["","56151146001","TRUE ","GLUCOSE","100","Select","Select",""],["","43598065530","BUPROPN ","150MG XL","90","Select","Select",""],["","00024586903","TOUJEO ","300IU\/ML","-14","Select","Select",""],["","72205000490","ROSUVASTATIN ","20MG","90","Select","Select",""],["","59746033990","LOSARTAN\/HCT ","100-25","90","Select","Select",""],["","00456122929","NAMZARIC ","","30","Select","Select",""],["","43547027511","DONEPEZIL ","5MG","30","Select","Select",""],["","56151146101","RELION ","METRIX","200","Select","Select",""],["","21292000908","","","100","Select","Select",""],["","65862014305","CARVEDILOL","6.25MG","180","Select","Select",""],["","72205000490","ROSUVASTATIN","20MG","90","Select","Select",""],["","59746033990","LOSARTAN\/HCT","100-25","90","Select","Select",""],["","56151146001","TRUE","GLUCOSE","100","Select","Select",""],["","43598065530","BUPROPN","150MG XL","90","Select","Select",""],["","00024586903","TOUJEO","300IU\/ML","-14","Select","Select",""],["","00003089421","ELIQUIS","5MG","180","Select","Select",""],["","68382009810","PAROXETINE","20MG","-90","Select","Select",""],["","00456122929","NAMZARIC","","30","Select","Select",""],["","43547027611","DONEPEZIL","10MG","30","Select","Select",""],["","56151146101","RELION","METRIX","200","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","",""],["Yes","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":""}]}]}