{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SONJA   D KELLY","gend":1,"add":"138 KELLY ROAD","city":"KINSALE","state":"VA","zip":"22488-9998","dob":"1962-10-03","age":"","mstatus":"","insh":"900042639*01","cliId":"2M74WY7ER99","pno":"804\/466-1293","cno":"804\/466-1293","email":"","ename":"","eno":"","pphy":"CLEARY, ANASTASIA D MD","ppno":"804\/443-6063","pcpadd":"300 MOUNT CLEMENT PARK SUITE C","pcpcity":"TAPPAHANNOCK","pcpstate":"VA","pcpzip":22560,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Tappahannock Family Practice","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/443-6005","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z51.81","Z79.01","Z95.2","Z12.31","R94.31","I34.0","K92.2","D50.9","E78.5","I10.","Z12.11"],"date":["2021-06-22","2021-06-22","2021-06-22","2021-01-11","2021-03-04","2021-03-04","2021-02-02","2021-07-07","2021-07-07","2021-07-07","2021-07-07"],"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":[["","65862056099","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","23155077210","ENALAPRIL ","10MG","180","Select","Select",""],["","00832532410","POT  CL MICRO","10MEQ ER","360","Select","Select",""],["","00093172110","WARFARIN ","5MG","90","Select","Select",""],["","16729000617","SIMVASTATIN ","40MG","90","Select","Select",""],["","69315011610","FUROSEMIDE ","20MG","270","Select","Select",""],["","68382009305","CARVEDILOL ","6.25MG","120","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","90","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","36","Select","Select",""],["","31722055190","LEVOCETIRIZI ","5MG","90","Select","Select",""],["","16729000617","","40MG","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","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}