{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA   M BOOKER","gend":1,"add":"702 EAST ST","city":"BLACKSTONE","state":"VA","zip":"23824-9998","dob":"1960-01-18","age":"","mstatus":"","insh":"900043089*01","cliId":"2UY5WR2HN60","pno":"434\/294-9166","cno":"434\/294-9166","email":"","ename":"","eno":"","pphy":"HALL, CLARENCE E MD","ppno":"434\/645-9191","pcpadd":"12522 W COLONIAL TRAIL HWY","pcpcity":"CREWE","pcpstate":"VA","pcpzip":23930,"pcpcounty":"","pcpid":110364,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/645-1859","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D64.9","I10.","N39.0","M06.9","M32.9","E03.9","R09.89","M17.0","R79.89","K76.0","Z12.11","R74.8","K57.30","E55.9","D69.6","M35.89","H25.13","Z12.31","G89.29","M35.9"],"date":["2021-10-19","2021-05-19","2021-01-20","2021-10-19","2021-09-02","2021-09-02","2021-01-20","2021-09-02","2021-10-19","2021-10-13","2021-03-25","2021-04-28","2021-03-25","2021-05-19","2021-06-11","2021-02-24","2021-02-05","2021-02-08","2021-05-19","2021-01-06"],"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":[["","68382032010","POT  CHLORIDE","10MEQ ER","90","Select","Select",""],["","65162083366","DICLOFENAC ","1%","-100","Select","Select",""],["","31722094101","HYDROCO\/APAP ","5-325MG","84","Select","Select",""],["","55111015834","OMEPRAZOLE ","20MG","-30","Select","Select",""],["","68382009605","HYDROXYCHLOR ","200MG","180","Select","Select",""],["","59746033890","LOSARTAN\/HCT ","100-12.5","-90","Select","Select",""],["","67877021560","CEFUROXIME ","250MG","14","Select","Select",""],["","62332006130","LEFLUNOMIDE ","10MG","90","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","72305011230","EUTHYROX ","112MCG","30","Select","Select",""],["","62332006130","","10MG","90","Select","Select",""],["","65162083366","DICLOFENAC","1%","100","Select","Select",""],["","62332006130","LEFLUNOMIDE","10MG","90","Select","Select",""],["","68382032010","POT CHLORIDE","10MEQ ER","90","Select","Select",""],["","55111015834","OMEPRAZOLE","20MG","30","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","84","Select","Select",""],["","59746033890","LOSARTAN\/HCT","100-12.5","-90","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","67877021560","CEFUROXIME","250MG","14","Select","Select",""],["","68382009605","HYDROXYCHLOR","200MG","180","Select","Select",""],["","72305011230","EUTHYROX","112MCG","30","Select","Select",""],["","00067815203","VOLTAREN","1%","100","Select","Select",""],["","45802006436","TRIAMCINOLON","0.10%","120","Select","Select",""],["","58160082311","SHINGRIX ","INJ 50\/0.5ML","-1","Select","Select",""],["","45802006436","TRIAMCINOLON ","CRE 0.001","-120","Select","Select",""],["","00067815203","VOLTAREN ","GEL 0.01","100","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":""}]}]}