{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" TERESA L JARRELL","gend":1,"add":"101 BRUNSWICK DR","city":"LYNCHBURG","state":"VA","zip":"24502-9998","dob":"1944-09-17","age":"","mstatus":"","insh":"900044922*01","cliId":"","pno":"434\/237-5958","cno":"434\/237-5958, 434\/841-4241","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"MA-NON DSNP","region":"WESTERN\/ CHARLOTTESVILLE","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":["E11.22","Z79.4","E11.3513","E11.42","E11.43","E11.59","N18.4","Z95.810","H02.403","E11.3593","I25.10","I50.22","R55.","I42.9","I10.","E78.5","G56.22","G56.02","M79.89","G99.0","Z95.0","D69.2","F33.0","E10.8"],"date":["2021-05-04","2021-03-29","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-13","2021-04-19","2021-04-19","2021-03-18","2021-03-18","2021-03-18","2021-04-23","2021-03-18","2021-03-18","2021-05-20","2021-05-20","2021-05-20","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-03-29"],"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":[["","68645052354","SERTRALINE ","100MG","60","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","270","Select","Select",""],["","00093220401","METOCLOPRAM ","5MG","270","Select","Select",""],["","72205000530","ROSUVASTATIN ","40MG","-90","Select","Select",""],["","55111064530","OMEPRAZOLE ","40MG","90","Select","Select",""],["","08508200005","OMNIPOD ","5 PACK","30","Select","Select",""],["","29300024716","BUSPIRONE ","30MG","180","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":""}]}]}