{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNA   M COULTER","gend":1,"add":"3711 W STEEPLECHASE WAY APT B","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1938-03-17","age":"","mstatus":"","insh":"900042590*01","cliId":"7HF1N59RQ05","pno":"757\/754-1917","cno":"757\/754-1917","email":"","ename":"","eno":"","pphy":"RAUCHWARG, GLENN MD","ppno":"757\/345-2071","pcpadd":"STE 201 5424 DISCOVERY PARK BLVD","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":181278,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"586\/945-4442","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/903-4877","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05.","Z20.828","Z03.818","E11.65","E78.2","I10.","R07.89","I65.23","Z20.822","E11.9","H01.02A","H01.02B","H04.121","H04.122","R07.9","I63.40","I48.20","L57.0","Z85.828","L57.8","L81.4","Z71.9","R53.1","Z79.01"],"date":["2021-05-26","2021-03-09","2021-03-09","2021-10-09","2021-09-13","2021-09-13","2021-05-14","2021-05-25","2021-03-09","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-05-14","2021-11-17","2021-11-17","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-11-17","2021-11-17"],"priorHcc":["","","",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":[["","016714004211","ALLOPURINOL ","300MG","90","Select","Select",""],["","057237010099","METOPROL ","25MG","90","Select","Select",""],["","000003089421","ELIQUIS ","5MG","180","Select","Select",""],["","068645058259","METFORMIN ","500MG","270","Select","Select",""],["","000093505898","ATORVASTATIN ","40MG","90","Select","Select",""],["","042806071401","BENZONATATE ","100MG","90","Select","Select",""],["","00003089421","","5MG","120","Select","Select",""],["","57237010099","METOPROL","25MG","90","Select","Select",""],["","00003089421","ELIQUIS","5MG","120","Select","Select",""],["","68645058259","METFORMIN","500MG","270","Select","Select",""],["","42806071401","BENZONATATE","100MG","90","Select","Select",""],["","16714004211","ALLOPURINOL","300MG","90","Select","Select",""],["","00093505898","ATORVASTATIN","40MG","90","Select","Select",""],["","00469260290","MYRBETRIQ ","TAB 50MG","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":[[["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":""}]}]}