{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM   R SEARS","gend":0,"add":"921 CHESTERFIELD TERRACE","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1980-04-21","age":"","mstatus":"","insh":"900043406*01","cliId":"4C10A00WM10","pno":"757\/549-0201","cno":"757\/549-0201","email":"","ename":"","eno":"","pphy":"HADEN, DAVID S MD","ppno":"757\/420-9573","pcpadd":"#101 5505 INDIAN RIVER RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":107599,"pcpname":"David S Haden MD","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"757\/617-6002","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/420-5649","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G82.50","G80.9","R39.81","Z99.3","N31.9","N39.46","M21.70","Z00.00","S83.92XA","F20.9","E78.9","Z23.","M79.605","M79.89","S86.912A","R79.9","E07.9","R79.89","E07.89","I10.","E78.5"],"date":["2021-10-08","2021-04-30","2021-10-21","2021-10-21","2021-10-21","2021-10-21","2021-04-30","2021-04-30","2021-10-27","2021-10-08","2021-10-08","2021-10-08","2021-10-11","2021-10-11","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08","2021-10-08"],"priorHcc":[null,"",null,null,null,null,"","",null,null,null,null,null,null,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":[["","55111017915","TIZANIDINE","TAB 2MG","120","Select","Select",""],["","23114501","BOTOX","INJ 100UNIT","4","Select","Select",""],["","832154011","HALOPERIDOL","TAB 5MG","60","Select","Select",""],["","51672129801","KETOCONAZOLE","CRE 0.02","45","Select","Select",""],["","55111017915","TIZANIDINE HCL","","120","Select","Select",""],["","00023114501","BOTOX                                                                 ","INJ 100UNIT","4","Select","Select",""],["","55111017915","TIZANIDINE HCL                                                        ","TAB 2MG","120","Select","Select",""],["","00832154011","HALOPERIDOL                                                           ","TAB 5MG","60","Select","Select",""],["","51672129801","KETOCONAZOLE                                                          ","CRE 0.02","45","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":""}]}]}