{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HELEN   W PINER","gend":1,"add":"1563 SUNKEN MEADOW ROAD SPRING GRV","city":"SPRING GROVE","state":"VA","zip":"23881-9998","dob":"1937-03-06","age":"","mstatus":"","insh":"900043996*01","cliId":"2G70DH7DJ43","pno":"757\/771-4940","cno":"757\/771-4940","email":"","ename":"","eno":"","pphy":"BUSH, JAMES A MD","ppno":"804\/458-8557","pcpadd":"815 W POYTHRESS ST","pcpcity":"HOPEWELL","pcpstate":"VA","pcpzip":23860,"pcpcounty":"","pcpid":164601,"pcpname":"Appomattox River Medical, LLC","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"CENTRAL","aligned":"","ano":"804\/894-7098","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/541-7113","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G20.","H53.2","J30.89","M35.3","D64.9","G47.00","M19.011","M54.15","R60.9","E11.9","I10.","M19.012","G83.14","F51.04","K59.01","R26.9"],"date":["2021-08-05","2021-04-26","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-03-08","2021-08-05","2021-08-05","2021-08-05"],"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":[["","57664037708","TRAMADOL ","50MG","120","Select","Select",""],["","62756046188","CARB\/LEVO ","25-100MG","360","Select","Select",""],["","23155050010","HYDROXYZ ","10MG","180","Select","Select",""],["","00781223410","OMEPRAZOLE ","40MG","180","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","-90","Select","Select",""],["","70436015542","PROMETHAZINE ","DM","120","Select","Select",""],["","45963067696","METOPROLOL ","50MG ER","90","Select","Select",""],["","57664050218","TIZANIDINE ","2MG","270","Select","Select",""],["","16729017117","AMITRIPTYLIN ","10MG","180","Select","Select",""],["","60505003307","PENTOXIFYLLI ","400MG ER","270","Select","Select",""],["","23155010210","METFORMIN ","500MG","270","Select","Select",""],["","50742061610","METOPROL ","50MG ER","-90","Select","Select",""],["","62756046188","","25-100MG","360","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","",""],["No","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":""}]}]}