{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUNE   M CROSS","gend":1,"add":"308 SOUTH WASHINGTON HWY LOT 62","city":"ASHLAND","state":"VA","zip":"23005-9998","dob":"1949-12-06","age":"","mstatus":"","insh":"900043420*01","cliId":"8QU6YN0TP55","pno":"804\/299-2129","cno":"804\/299-2129","email":"","ename":"","eno":"","pphy":"GANLEY, DONALD T MD","ppno":"804\/798-1092","pcpadd":"STE 306 201 N WASHINGTON HWY","pcpcity":"ASHLAND","pcpstate":"VA","pcpzip":23005,"pcpcounty":"","pcpid":117493,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/798-1475","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.562","M17.12","E66.9","S82.092A","G25.81","G47.00","J45.40","M79.672","S82.002A","R06.02","Z98.890","M76.72","M21.6X2","M21.6X1","R93.6","M65.9","M25.572"],"date":["2021-04-26","2021-05-06","2021-05-06","2021-05-06","2021-05-17","2021-05-17","2021-05-17","2021-08-09","2021-04-26","2021-04-06","2021-04-26","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-07-16","2021-07-16"],"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":[["","43547027110","ROPINIROLE ","2MG","270","Select","Select",""],["","00487950160","ALBUTEROL ","0.08%","-90","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","68382091634","METHYLPRED ","4MG","-21","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","90","Select","Select",""],["","00378023110","ATENOLOL ","50MG","90","Select","Select",""],["","64380071206","BENZONATATE ","100MG","30","Select","Select",""],["","65162062711","TRAMADOL ","50MG","-40","Select","Select",""],["","60432060416","PROMETHAZINE ","DM","120","Select","Select",""],["","00093720298","PRAVASTATIN ","40MG","90","Select","Select",""],["","65162055610","TEMAZEPAM ","15MG","90","Select","Select",""],["","00591505243","PREDNISONE ","5MG","-48","Select","Select",""],["","69315090405","LORAZEPAM ","0.5MG","20","Select","Select",""],["","00378023110","","50MG","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":[[["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":""}]}]}