{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRIS   H PHELPS","gend":1,"add":"8660 GUINEA ROAD","city":"HAYES","state":"VA","zip":"23072-9998","dob":"1941-09-30","age":"","mstatus":"","insh":"900043565*01","cliId":"1J11RP6DU05","pno":"804\/252-0438","cno":"804\/252-0438","email":"","ename":"","eno":"","pphy":"ALEJO, ANDREA J MD","ppno":"804\/693-2720","pcpadd":"SUITE 2200 7547 MEDICAL DRIVE","pcpcity":"GLOUCESTER","pcpstate":"VA","pcpzip":23061,"pcpcounty":"","pcpid":118380,"pcpname":"Internal Medicine Associates of Gloucester","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/694-0597","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M17.11","I10.","F41.8","M17.12","M25.561","J45.909","G89.29","M25.551","M11.261","M16.0","M47.26","M47.27","M43.16","M54.16","M51.16","M25.511","M75.51","M75.41","Z12.31","H90.3","M19.011"],"date":["2021-03-02","2021-06-03","2021-06-03","2021-03-02","2021-03-02","2021-06-03","2021-03-02","2021-07-09","2021-01-07","2021-06-08","2021-06-08","2021-06-08","2021-06-08","2021-07-12","2021-06-08","2021-08-20","2021-08-20","2021-08-20","2021-10-28","2021-11-08","2021-08-20"],"priorHcc":["","","","","","","","","","","","","","","","","","",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":[["","43547034703","PAROXETINE ","10MG","90","Select","Select",""],["","00173071620","ADVAIR ","115\/21","36","Select","Select",""],["","69097012715","AMLODIPINE ","5MG","90","Select","Select",""],["","42806040021","METHYLPRED ","4MG","21","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","43547034703","","10MG","90","Select","Select",""],["","43547034703","PAROXETINE","10MG","90","Select","Select",""],["","00173071620","ADVAIR","115\/21","12","Select","Select",""],["","69097012715","AMLODIPINE","5MG","90","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","42806040021","METHYLPRED","4MG","21","Select","Select",""],["","13668008105","MONTELUKAST","10MG","90","Select","Select",""],["","13668008105","MONTELUKAST ","TAB 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":[[["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":""}]}]}