{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GEARY   L SMITH","gend":0,"add":"374 GREEN VALLEY RD","city":"LEBANON","state":"VA","zip":"24266-9998","dob":"1954-10-11","age":"","mstatus":"","insh":"900044338*01","cliId":"1MF8KU0GK61","pno":"276\/254-9945","cno":"276\/254-9945","email":"","ename":"","eno":"","pphy":"EASTON, BRIAN THOMAS MD","ppno":"276\/889-3700","pcpadd":"495 EAST MAIN ST","pcpcity":"LEBANON","pcpstate":"VA","pcpzip":24266,"pcpcounty":"","pcpid":123215,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"276\/701-6806","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/889-5505","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R33.9","N35.819","N39.0","R31.29","H65.02","H92.02","I10."],"date":["2021-11-23","2021-11-23","2021-04-23","2021-11-23","2021-06-24","2021-07-31","2021-07-02"],"priorHcc":[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":[["","68645055254","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","180","Select","Select",""],["","68382013201","TAMSULOSIN HYDROCHLORIDE","","180","Select","Select",""],["","00143924920","AMOXICILLIN\/CLAVULANATE POTASSIUM","","20","Select","Select",""],["","00054001925","PREDNISONE","","5","Select","Select",""],["","69238110002","DOXYCYCLINE HYCLATE","100MG","20","Select","Select",""],["","61314064610","NEOMYCIN\/POLYMYXIN\/HYDROCORTISONE","1% OTIC","10","Select","Select",""],["","68645055254","LISINOPRIL                                                            ","TAB 10MG","90","Select","Select",""],["","68382013201","TAMSULOSIN HYDROCHLORIDE                                              ","CAP 0.4MG","180","Select","Select",""],["","00143924920","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","TAB 875-125","20","Select","Select",""],["","00054001925","PREDNISONE                                                            ","TAB 50MG","5","Select","Select",""],["","61314064610","NEOMYCIN\/POLYMYXIN\/HYDROCORTISONE                                     ","SOL 1% OTIC","10","Select","Select",""],["","49281042150","FLUZONE QUADRIVALENT 2021-2022                                        ","INJ 2021-22","0","Select","Select",""],["","69238110002","DOXYCYCLINE HYCLATE                                                   ","CAP 100MG","20","Select","Select",""],["","49281012165","FLUZONE HIGH-DOSE PF 2021-2022                                        ","INJ 2021-22","-1","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":""}]}]}