{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALFRED   P TIGGLE","gend":0,"add":"148 JENKINS DR","city":"WEEMS","state":"VA","zip":"22576-9998","dob":"1943-01-03","age":"","mstatus":"","insh":"900043214*01","cliId":"7PY6NY3PR61","pno":"804\/435-1275","cno":"804\/435-1275","email":"","ename":"","eno":"","pphy":"CUBBAGE, BRIAN K MD","ppno":"804\/435-3133","pcpadd":"30 SHADY LANE","pcpcity":"WHITE STONE","pcpstate":"VA","pcpzip":22578,"pcpcounty":"","pcpid":118380,"pcpname":"White Stone Family Practice","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/435-1311","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","F17.210","M1A.9XX0","H40.1111","M10.9","I77.9","Z00.00","M1A.0410","H40.1123","Z96.1","Z23."],"date":["2021-09-24","2021-09-24","2021-03-10","2021-07-02","2021-02-19","2021-09-15","2021-06-11","2021-09-24","2021-07-02","2021-07-02","2021-09-24"],"priorHcc":[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":[["","70069005101","DORZOL\/TIMOL ","22.3-6.8","10","Select","Select",""],["","68645051654","AMLODIPINE ","10MG","90","Select","Select",""],["","68645019159","METOPROL ","100MG","90","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","60","Select","Select",""],["","70069042101","LATANOPROST ","0.01%","8","Select","Select",""],["","68645051654","","10MG","90","Select","Select",""],["","70069005101","DORZOL\/TIMOL","22.3-6.8","10","Select","Select",""],["","68645051654","AMLODIPINE","10MG","90","Select","Select",""],["","68645019159","METOPROL","100MG","90","Select","Select",""],["","70069042101","LATANOPROST","0.01%","8","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","60","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","",""],["No","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":""}]}]}