{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JASON   E RADFORD","gend":0,"add":"301 MAIN ST","city":"PENNINGTON GAP","state":"VA","zip":"24277-9998","dob":"1975-03-21","age":"","mstatus":"","insh":"900042992*01","cliId":"3C59NG3MN24","pno":"276\/210-6978","cno":"276\/210-6978","email":"","ename":"","eno":"","pphy":"ALMATARI, ABDUL LATIEF MD","ppno":"276\/546-3001","pcpadd":"276 FIELDSTONE DRIVE","pcpcity":"JONESVILLE","pcpstate":"VA","pcpzip":24263,"pcpcounty":"","pcpid":143426,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"276\/282-0764","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/546-9705","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.41","Z00.8","Z13.9","Z13.89","F17.200","I10.","E78.5","K21.9","E66.09","D69.6","Z00.01","E11.9","F17.208","Z68.34","E78.2","Z23.","M25.522","E11.65","E86.0","R06.02"],"date":["2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-02-09","2021-09-02","2021-02-09","2021-09-02","2021-02-09","2021-01-12","2021-03-29","2021-06-01","2021-03-29","2021-03-29","2021-09-02","2021-09-23","2021-07-20","2021-09-02","2021-07-28","2021-07-28"],"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":[["","57237001899","DULOXETINE","CAP 30MG","-30","Select","Select",""],["","781223410","OMEPRAZOLE","CAP 40MG","-90","Select","Select",""],["","13668033205","TRAZODONE","TAB 150MG","90","Select","Select",""],["","6027731","JANUVIA","TAB 100MG","30","Select","Select",""],["","68382013510","LOSARTAN POT","TAB 25MG","90","Select","Select",""],["","60505014201","GLIPIZIDE","TAB 10MG","180","Select","Select",""],["","69097094705","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","57237001899","DULOXETINE HYDROCHLORIDE","","30","Select","Select",""],["","6027731","JANUVIA ","","30","Select","Select",""],["","13668033205","TRAZODONE HYDROCHLORIDE","","90","Select","Select",""],["","68382013510","LOSARTAN POTASSIUM ","","90","Select","Select",""],["","60505014201","GLIPIZIDE ","","180","Select","Select",""],["","69097094705","ATORVASTATIN CALCIUM ","","90","Select","Select",""],["","69097094705","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","68382013510","LOSARTAN POTASSIUM","","90","Select","Select",""],["","69097082112","GEMFIBROZIL","600MG","180","Select","Select",""],["","69097094705","ATORVASTATIN CALCIUM                                                  ","TAB 80MG","90","Select","Select",""],["","57237001899","DULOXETINE HYDROCHLORIDE                                              ","CAP 30MG","30","Select","Select",""],["","00006027731","JANUVIA                                                               ","TAB 100MG","30","Select","Select",""],["","60505014201","GLIPIZIDE                                                             ","TAB 10MG","180","Select","Select",""],["","68382013510","LOSARTAN POTASSIUM                                                    ","TAB 25MG","90","Select","Select",""],["","00781223410","OMEPRAZOLE                                                            ","CAP 40MG","-90","Select","Select",""],["","13668033205","TRAZODONE HYDROCHLORIDE                                               ","TAB 150MG","90","Select","Select",""],["","00006483703","PNEUMOVAX 23                                                          ","INJ 25\/0.5","0","Select","Select",""],["","69097082112","GEMFIBROZIL                                                           ","TAB 600MG","180","Select","Select",""],["","00005197105","PREVNAR 13                                                            ","INJ ","0","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":""}]}]}