{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES   R GRAY JR","gend":0,"add":"1233 DESHA ROAD","city":"TAPPAHANNOCK","state":"VA","zip":"22560-9998","dob":"1963-06-24","age":"","mstatus":"","insh":"900043651*01","cliId":"1MF8TX6GK61","pno":"804\/925-9543","cno":"804\/925-9543","email":"","ename":"","eno":"","pphy":"WILLIAMS, RYAN G DO","ppno":"757\/251-2170","pcpadd":"850 ENTERPRISE PKWY STE 2200","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Tappahannock Family Practice","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/251-2185","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C61.","R10.13","N40.0","R07.9","E78.49","I10.","E11.42","Z79.4","R07.89","I47.1","E11.9","E78.5","Z91.81","Z87.891","E66.9","Z68.38","E11.49","M10.9","Z85.46","I69.359","G47.00","R97.20","R39.11","N52.9","R94.31","E78.2","E66.01","K21.9","M25.512","Z00.00","G89.29"],"date":["2021-11-02","2021-04-18","2021-04-18","2021-04-19","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-07-16","2021-04-21","2021-04-21","2021-05-11","2021-08-18","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-08-18","2021-08-18","2021-08-18","2021-05-11","2021-08-12","2021-11-02","2021-11-02","2021-07-16","2021-07-16","2021-08-18","2021-08-18","2021-08-19","2021-08-18","2021-08-19"],"priorHcc":[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":[["","00169183302","NOVOLIN ","RELION","-10","Select","Select",""],["","69097012815","AMLODIPINE ","10MG","-90","Select","Select",""],["","65862011801","BENAZEPRIL ","40MG","-90","Select","Select",""],["","60505267108","ATORVASTATIN ","80MG","90","Select","Select",""],["","43598071910","CHLORTHALID ","25MG","90","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","65862056099","PANTOPRAZOLE ","40MG","-90","Select","Select",""],["","70954000530","OXYBUTYNIN ","5MG","-90","Select","Select",""],["","81131038679","RELION ","32GX4MM","-100","Select","Select",""],["","50111056102","TRAZODONE ","100MG","90","Select","Select",""],["","68382009505","CARVEDILOL ","25MG","-180","Select","Select",""],["","62756014202","METFORMIN ","500MG ER","180","Select","Select",""],["","16729021816","CLOPIDOGREL ","75MG","90","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","-40","Select","Select",""],["","68382013201","TAMSULOSIN ","0.4MG","60","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA","300","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","14","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","60","Select","Select",""],["","68382013201","","0.4MG","60","Select","Select",""],["","00169183302","NOVOLIN","RELION","10","Select","Select",""],["","81131038679","RELION","32GX4MM","-100","Select","Select",""],["","69097014260","ALBUTEROL","HFA","-40","Select","Select",""],["","50111056102","TRAZODONE","100MG","90","Select","Select",""],["","43598071910","CHLORTHALID","25MG","-90","Select","Select",""],["","00088221905","LANTUS","100\/ML","-15","Select","Select",""],["","65862011801","BENAZEPRIL","40MG","90","Select","Select",""],["","70954000530","OXYBUTYNIN","5MG","90","Select","Select",""],["","16729021816","CLOPIDOGREL","75MG","90","Select","Select",""],["","69097012815","AMLODIPINE","10MG","-90","Select","Select",""],["","68382009505","CARVEDILOL","25MG","-180","Select","Select",""],["","62756014202","METFORMIN","500MG ER","-180","Select","Select",""],["","60505267108","ATORVASTATIN","80MG","90","Select","Select",""],["","65862056099","PANTOPRAZOLE","40MG","90","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","60","Select","Select",""],["","53885004601","ONETOUCH","ULTRA 2","1","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","14","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","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":[[["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":""}]}]}