{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARAH   M PRICE","gend":1,"add":"206 NELSON ST","city":"CREWE","state":"VA","zip":"23930-9998","dob":"1952-10-22","age":"","mstatus":"","insh":"900043232*01","cliId":"9FF3KY4NV09","pno":"434\/480-6741","cno":"434\/480-6741","email":"","ename":"","eno":"","pphy":"MARSTON, JONATHAN 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":["E11.9","I10.","I25.10","M25.512","R80.9","R79.89","H25.13","Z12.11","E78.2"],"date":["2021-09-02","2021-09-02","2021-09-02","2021-01-15","2021-02-19","2021-06-18","2021-08-02","2021-05-23","2021-09-02"],"priorHcc":[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":[["","31722070090","LOSARTAN ","25MG","30","Select","Select",""],["","59746021601","SPIRONOLACT ","25MG","30","Select","Select",""],["","69238115403","EZETIMIBE ","10MG","30","Select","Select",""],["","23155010410","METFORMIN ","1000MG","90","Select","Select",""],["","68645052254","SERTRALINE ","50MG","90","Select","Select",""],["","59310057922","PROAIR ","","26","Select","Select",""],["","00536123441","ASPIRIN ","81MG EC","90","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","26","Select","Select",""],["","68645051654","AMLODIPINE ","10MG","90","Select","Select",""],["","00093505698","ATORVASTATIN ","10MG","90","Select","Select",""],["","52817036000","METOPROL ","25MG","60","Select","Select",""],["","00093505698","","10MG","30","Select","Select",""],["","59746021601","SPIRONOLACT","25MG","30","Select","Select",""],["","00093505698","ATORVASTATIN","10MG","30","Select","Select",""],["","31722070090","LOSARTAN","25MG","-30","Select","Select",""],["","59310057922","PROAIR","","26","Select","Select",""],["","69238115403","EZETIMIBE","10MG","30","Select","Select",""],["","00536123441","ASPIRIN","81MG EC","90","Select","Select",""],["","23155010410","METFORMIN","1000MG","90","Select","Select",""],["","00093317431","ALBUTEROL","HFA","-26","Select","Select",""],["","65862001205","SERTRALINE","50MG","90","Select","Select",""],["","45963070996","METOPROL","25MG ER","45","Select","Select",""],["","69097012815","AMLODIPINE","10MG","90","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","",""],["Yes","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":""}]}]}