{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NEOLA B GAINES","gend":1,"add":"401 BARBEE ST","city":"BRIDGEWATER","state":"VA","zip":"22812-9998","dob":"1940-06-09","age":"","mstatus":"","insh":"900044957*01","cliId":"","pno":"540\/828-6025","cno":"540\/828-6025, ","email":"","ename":"","eno":"","pphy":"ASHBY, JEFFREY A MD","ppno":"540\/433-9151","pcpadd":"1831 RESERVOIR ST","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":"22801-9998","pcpcounty":"","pcpid":113977,"pcpname":"Harrisonburg Family Practice Associates","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":["I50.21","I50.9","N39.0","B37.2","M62.89","I50.30","E78.5","I08.1","I70.0","I11.0","Z68.42","Z66.","I50.33","E66.01","R79.1","I89.0","I35.8","M19.90","E21.1","E55.9","E88.09","Z20.822","Z79.899","Z79.01","R26.2","R06.02","K57.32","I10.","I26.99","I25.2","E83.51"],"date":["2021-05-23","2021-05-23","2021-05-23","2021-05-23","2021-06-01","2021-06-01","2021-06-01","2021-05-23","2021-05-23","2021-05-22","2021-05-22","2021-05-22","2021-05-28","2021-05-22","2021-05-22","2021-05-22","2021-05-22","2021-05-22","2021-05-22","2021-05-22","2021-05-22","2021-05-22","2021-05-22","2021-05-22","2021-05-28","2021-06-13","2021-04-23","2021-04-23","2021-04-23","2021-05-27","2021-05-27"],"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":[["","50742061610","METOPROL ","50MG ER","180","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","90","Select","Select",""],["","00245531911","KLOR-CON ","20MEQ ER","180","Select","Select",""],["","70377000315","SIMVASTATIN ","20MG","90","Select","Select",""],["","00093171401","WARFARIN ","2.5MG","90","Select","Select",""],["","00003089421","ELIQUIS ","5MG","-60","Select","Select",""],["","50458057930","XARELTO ","20MG","30","Select","Select",""],["","10702001801","OXYCODONE ","5MG","20","Select","Select",""],["","70377002711","ATORVASTATIN ","10MG","30","Select","Select",""],["","88395014110","VITAMIN ","5000UNIT","4","Select","Select",""],["","00378021610","FUROSEMIDE ","40MG","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}