{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARRY   D HOWARD","gend":0,"add":"6100 ALLERTON ST","city":"RICHMOND","state":"VA","zip":"23234-9998","dob":"1938-03-04","age":"","mstatus":"","insh":"900045229*01","cliId":"4Q11VE1HJ37","pno":"804\/461-1276","cno":"804\/461-1276","email":"","ename":"","eno":"","pphy":"GEORGE, LEELAMMA MD","ppno":"804\/526-8640","pcpadd":"215 TEMPLE AVE","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":23834,"pcpcounty":"","pcpid":127805,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/526-4321","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R13.10","C44.519","L90.5","E11.69","I10.","R33.8","R91.1","R35.1","E11.22","E78.5","I25.10","I25.2","L81.4","D23.71","L57.0","M47.812","G89.29","Z01.812","E11.9","Z79.82","Z79.84","Z79.899","Z86.16","Z87.891","Z95.0","Z95.1","M18.0","K22.0","K22.2","M17.11","Z79.891","Z45.010","Z85.828","D48.5","L82.1","D18.01","D23.9","Z20.822","T83.410A","L82.0","H35.3213","H35.3122","Z96.1","H52.222","H43.813","G89.4","M50.20"],"date":["2021-02-02","2021-05-11","2021-02-09","2021-05-25","2021-05-25","2021-01-21","2021-01-21","2021-01-21","2021-02-02","2021-02-10","2021-02-10","2021-02-10","2021-07-12","2021-02-10","2021-07-12","2021-07-28","2021-07-28","2021-02-16","2021-04-05","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-02-10","2021-07-28","2021-01-11","2021-02-02","2021-03-03","2021-07-28","2021-01-25","2021-02-10","2021-07-12","2021-02-10","2021-02-10","2021-02-10","2021-02-16","2021-02-19","2021-07-12","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-07-28","2021-07-28"],"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":[["","062332004590","VALSARTAN ","80MG","90","Select","Select",""],["","000006011231","JANUVIA ","50MG","90","Select","Select",""],["","053885024510","ONETOUCH ","ULTRA","100","Select","Select",""],["","055111064534","OMEPRAZOLE ","40MG","-90","Select","Select",""],["","000591090030","GLIPIZIDE ","2.5MG","90","Select","Select",""],["","000054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","060505612902","BUDESONIDE ","32MCG","8","Select","Select",""],["","065162037110","OXYBUTYNIN ","5MG ER","90","Select","Select",""],["","065862029490","ROSUVASTATIN ","10MG","90","Select","Select",""],["","045802065087","LORATADINE ","10MG","30","Select","Select",""],["","068180012202","CEPHALEXIN ","500MG","21","Select","Select",""],["","000143314250","DOXYCYCL ","100MG","14","Select","Select",""],["","042806001201","MECLIZINE ","12.5MG","30","Select","Select",""],["","62332004590","","80MG","90","Select","Select",""],["","62332004590","VALSARTAN","80MG","90","Select","Select",""],["","00006011231","JANUVIA","50MG","90","Select","Select",""],["","53885024510","ONETOUCH","ULTRA","100","Select","Select",""],["","55111064530","OMEPRAZOLE","40MG","90","Select","Select",""],["","00591090030","GLIPIZIDE","2.5MG","90","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","65862029490","ROSUVASTATIN","10MG","90","Select","Select",""],["","42806001201","MECLIZINE","12.5MG","30","Select","Select",""],["","60505612902","BUDESONIDE","32MCG","8","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","-21","Select","Select",""],["","65162037110","OXYBUTYNIN","5MG ER","90","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","30","Select","Select",""],["","00406012501","HYDROCO\/APAP","10-325MG","-14","Select","Select",""],["","45802065087","LORATADINE","10MG","30","Select","Select",""],["","00143314250","DOXYCYCL","100MG","14","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":""}]}]}