{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" BARBARA J DAVIS","gend":1,"add":"3240 LUTTRELLVILLE LN","city":"FARNHAM","state":"VA","zip":"22460-9998","dob":"1943-10-23","age":"","mstatus":"","insh":"900044667*01","cliId":"","pno":"804\/333-1181","cno":"804\/333-1181, ","email":"","ename":"","eno":"","pphy":"DUNN, RICHARD K MD","ppno":"804\/333-1260","pcpadd":"16 DELFAE DRIVE","pcpcity":"WARSAW","pcpstate":"VA","pcpzip":"22572-9998","pcpcounty":"","pcpid":118380,"pcpname":"Riverside Warsaw Medical Arts","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"MA-NON DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D04.72","D04.5","D48.5","L57.8","L24.5","E78.5","E03.9","G57.93","Z12.11","E53.8","G47.61","E11.9","E55.9","H40.1132","H26.491","H04.123","H35.363","H01.00A","H01.00B","E11.40","I10.","H40.9"],"date":["2021-04-23","2021-04-23","2021-03-05","2021-03-26","2021-03-26","2021-06-14","2021-06-14","2021-06-14","2021-06-07","2021-06-14","2021-06-14","2021-06-07","2021-06-14","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2021-06-14","2021-06-14","2021-06-14"],"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":[["","51672411806","FLUOROURACIL ","5%","40","Select","Select",""],["","68382041205","OMEPRAZOLE ","20MG","90","Select","Select",""],["","69238183107","LEVOTHYROXIN ","50MCG","90","Select","Select",""],["","00093720110","PRAVASTATIN ","20MG","90","Select","Select",""],["","68180021509","LOSARTAN\/HCT ","50-12.5","-90","Select","Select",""],["","61314014310","BRIMONIDINE ","0.2% OP","30","Select","Select",""],["","61314054701","LATANOPROST ","0.01%","-8","Select","Select",""],["","23155010210","METFORMIN ","500MG","180","Select","Select",""],["","00472011720","TRETINOIN ","0.03%","20","Select","Select",""],["","61314022715","TIMOLOL ","0.5% OP","45","Select","Select",""],["","69097081312","GABAPENTIN ","100MG","30","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":""}]}]}