{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GLORIA   K GARRISON","gend":1,"add":"1861 SPLIT RAIL LN","city":"MCGAHEYSVILLE","state":"VA","zip":"22840-9998","dob":"1945-02-24","age":"","mstatus":"","insh":"900043100*01","cliId":"8TR2VN9FH08","pno":"540\/289-5637","cno":"540\/289-5637","email":"","ename":"","eno":"","pphy":"NIO, DEBORAH A MD","ppno":"540\/433-9151","pcpadd":"1831 RESERVOIR ST","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":113977,"pcpname":"Harrisonburg Family Practice Associates","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/433-0547","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z96.651","M25.561","R30.0","M25.461","E11.65","E78.5","I10.","M25.661","M11.262","R26.89","Z47.1","E11.9","M65.861","M25.469"],"date":["2021-02-26","2021-02-03","2021-03-17","2021-02-25","2021-06-16","2021-06-16","2021-06-16","2021-02-26","2021-02-03","2021-02-03","2021-02-03","2021-02-17","2021-02-25","2021-02-25"],"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":[["","050111056003","TRAZODONE ","50MG","30","Select","Select",""],["","000093078710","ATENOLOL ","25MG","90","Select","Select",""],["","068462026390","ROSUVASTATIN ","20MG","90","Select","Select",""],["","057237022005","PIOGLITAZONE ","30MG","90","Select","Select",""],["","000832532410","POT  CL MICRO","10MEQ ER","90","Select","Select",""],["","068180052002","LISINOP\/HCTZ ","20-25MG","90","Select","Select",""],["","000143992701","CIPROFLOXACN ","250MG","10","Select","Select",""],["","068180012202","CEPHALEXIN ","500MG","4","Select","Select",""],["","50111056003","","50MG","30","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":""}]}]}