{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN   T BONNEY","gend":0,"add":"900 FIRST COLONIAL ROAD","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1950-01-21","age":"","mstatus":"","insh":"900046236*01","cliId":"4TT8CV8MN33","pno":"757\/449-8695","cno":"Non-DSNP","email":"","ename":"","eno":"","pphy":"PATTERSON, JOHN ROBERT MD","ppno":"248\/824-6003","pcpadd":"236 CLEARFIELD AVE STE 215","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":159520,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"757\/449-8695","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":["I10.","K50.80","E44.0","E87.6","R53.81","E78.00","Z00.01","H02.102","B02.9"],"date":["2021-09-14","2021-06-30","2021-09-14","2021-03-15","2021-03-15","2021-06-30","2021-06-30","2021-05-11","2021-09-14"],"priorHcc":[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":[["","11822511150","RA VIT B-12","TAB 1000 TR","30","Select","Select",""],["","245003660","PREVALITE","POW 4GM PK","30","Select","Select",""],["","50742026101","NIFEDIPINE","TAB 60MG ER","-90","Select","Select",""],["","68180079901","POT CHLORIDE","CAP 10MEQ ER","90","Select","Select",""],["","245003660","PREVALITE ","","30","Select","Select",""],["","11822511150","RA VITAMIN B-12 TR ","","30","Select","Select",""],["","50742026101","NIFEDIPINE ER ","","-90","Select","Select",""],["","68180079901","POTASSIUM CHLORIDE ER","","90","Select","Select",""],["","11822511150","RA VITAMIN B-12 TR","","30","Select","Select",""],["","50742026101","NIFEDIPINE ER","","90","Select","Select",""],["","31722077801","ACYCLOVIR","800MG","-25","Select","Select",""],["","00245003660","PREVALITE                                                             ","POW 4GM PK","30","Select","Select",""],["","68180079901","POTASSIUM CHLORIDE ER                                                 ","CAP 10MEQ ER","90","Select","Select",""],["","50742026101","NIFEDIPINE ER                                                         ","TAB 60MG ER","-90","Select","Select",""],["","11822511150","RA VITAMIN B-12 TR                                                    ","TAB 1000 TR","30","Select","Select",""],["","31722077801","ACYCLOVIR                                                             ","TAB 800MG","25","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":""}]}]}