{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAROLD   E SEWARD","gend":0,"add":"3777 OTTOBINE ROAD","city":"DAYTON","state":"VA","zip":"22821-9998","dob":"1938-04-10","age":"","mstatus":"","insh":"900042561*01","cliId":"9X16E22TF54","pno":"540\/830-1701","cno":"540\/830-1701","email":"","ename":"","eno":"","pphy":"SYPTAK, J MICHAEL MD","ppno":"540\/433-9151","pcpadd":"1831 RESERVOIR ST","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":113977,"pcpname":"Harrisonburg Family Practice Associates","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/433-0547","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R31.0","N18.32","I25.10","I42.8","N18.30","Z95.810","E78.5","I10.","I42.0","N28.9","I44.2","M79.674","M79.675","B35.1","I50.22","J32.9","R05.","I50.9","I08.8","J90.","N48.1","I51.7","N47.2"],"date":["2021-10-12","2021-09-14","2021-08-10","2021-08-10","2021-08-10","2021-08-30","2021-09-14","2021-09-14","2021-08-30","2021-04-07","2021-06-01","2021-04-20","2021-04-20","2021-11-08","2021-09-14","2021-06-30","2021-06-30","2021-08-18","2021-08-18","2021-08-18","2021-10-26","2021-08-18","2021-10-26"],"priorHcc":[null,null,"","","",null,null,null,null,"","","","",null,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":[["","13668010401","ISOSORB ","30MG ER","90","Select","Select",""],["","43547040111","FUROSEMIDE ","20MG","90","Select","Select",""],["","69315090405","LORAZEPAM ","0.5MG","30","Select","Select",""],["","47781064990","LEVOTHYROXIN ","88MCG","90","Select","Select",""],["","27241012502","RANOLAZINE ","500MG ER","54","Select","Select",""],["","16714004211","ALLOPURINOL ","300MG","30","Select","Select",""],["","68382009405","CARVEDILOL ","12.5MG","60","Select","Select",""],["","16714035602","LEVETIRACETA ","750MG","-60","Select","Select",""],["","62332002231","FLUOXETINE ","10MG","90","Select","Select",""],["","29300022019","MONTELUKAST ","10MG","90","Select","Select",""],["","72205002790","ROSUVASTATIN ","5MG","90","Select","Select",""],["","00555060702","MEGESTROL ","40MG","30","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","28","Select","Select",""],["","72305008830","EUTHYROX ","88MCG","90","Select","Select",""],["","00143924920","AMOX\/K ","875-125","14","Select","Select",""],["","13668010401","","30MG ER","90","Select","Select",""],["","43547040111","FUROSEMIDE","20MG","90","Select","Select",""],["","69315090405","LORAZEPAM","0.5MG","30","Select","Select",""],["","27241012502","RANOLAZINE","500MG ER","54","Select","Select",""],["","13668010401","ISOSORB","30MG ER","90","Select","Select",""],["","29300022019","MONTELUKAST","10MG","90","Select","Select",""],["","16714004211","ALLOPURINOL","300MG","30","Select","Select",""],["","68382009405","CARVEDILOL","12.5MG","60","Select","Select",""],["","62332002231","FLUOXETINE","10MG","90","Select","Select",""],["","47781064990","LEVOTHYROXIN","88MCG","90","Select","Select",""],["","72205002790","ROSUVASTATIN","5MG","90","Select","Select",""],["","16714035602","LEVETIRACETA","750MG","60","Select","Select",""],["","00555060702","MEGESTROL","40MG","30","Select","Select",""],["","72305008830","EUTHYROX","88MCG","90","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","28","Select","Select",""],["","00143924920","AMOX\/K","875-125","14","Select","Select",""],["","45802005535","TRIAMCINOLON","0.10%","15","Select","Select",""],["","45802005535","TRIAMCINOLON ","OIN 0.001","15","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":""}]}]}