{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA  D CARWILE","gend":1,"add":"5908 WOODGROVE LN","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1947-08-19","age":"","mstatus":"","insh":"900042964*01","cliId":"9MH6KE0YD66","pno":"757\/418-0370","cno":"757\/418-0370","email":"","ename":"","eno":"","pphy":"PHYSICIAN, MR PRIMARY CARE MD","ppno":"","pcpadd":"4417 CORPORATION LANE","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"799MR","pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","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":["G10.","F42.9","R26.89","Z00.00","E78.00","I10.","E55.9","M54.5","S39.92XA","M54.2","S01.01XA","R35.0","R41.89","R46.89","S32.591A","M81.0","M51.36","Z95.1","Z88.8","Z88.5","M25.551","S32.511A","S32.9XXD","F03.90","S32.9XXA","S01.112A","F02.80","Z20.822","F33.9","E78.5","E46.","Z86.79","W19.XXXA","Z74.01","Z74.3","Z04.3","F02.81","R13.12","Z78.9","Z23.","E03.9"],"date":["2021-07-23","2021-04-14","2021-07-23","2021-04-14","2021-04-14","2021-07-15","2021-06-22","2021-06-01","2021-06-01","2021-06-04","2021-06-04","2021-05-28","2021-05-28","2021-05-28","2021-06-01","2021-06-01","2021-06-01","2021-06-02","2021-06-02","2021-06-02","2021-06-01","2021-06-04","2021-06-07","2021-06-02","2021-07-15","2021-06-02","2021-06-02","2021-06-02","2021-06-07","2021-06-07","2021-06-07","2021-06-01","2021-06-01","2021-06-05","2021-06-05","2021-06-01","2021-07-23","2021-07-23","2021-07-23","2021-06-07","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":[["","68180044501","QUETIAPINE","TAB 25MG","180","Select","Select",""],["","68645047054","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","68382009906","PAROXETINE","TAB 30MG","180","Select","Select",""],["","69238183107","LEVOTHYROXIN","TAB 50MCG","90","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","69452015120","VITAMIN D ","","12","Select","Select",""],["","69238183107","LEVOTHYROXINE SODIUM ","","90","Select","Select",""],["","68382009906","PAROXETINE HCL","","180","Select","Select",""],["","68180044501","QUETIAPINE FUMARATE","","180","Select","Select",""],["","406012301","HYDROCODONE\/ACETAMINOPHEN ","","18","Select","Select",""],["","52817036000","METOPROLOL TARTRATE","","180","Select","Select",""],["","57237007710","ONDANSETRON ODT ","","12","Select","Select",""],["","69238183107","LEVOTHYROXINE SODIUM","","90","Select","Select",""],["","57237007710","ONDANSETRON ODT","","12","Select","Select",""],["","00406012301","HYDROCODONE\/ACETAMINOPHEN","","18","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":""}]}]}