{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDREA   Y JOYNER","gend":1,"add":"3323 CUTSHAW AVE APT A1","city":"RICHMOND","state":"VA","zip":"23230-9998","dob":"1962-12-02","pno":"804\/819-9748","cno":"804\/819-9748","email":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","insh":"900046282*01","cliId":"2WX6E08EU52","plan":"OHP","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":["Z12.31","R07.9","R06.00","Z79.899","J45.909","L98.9","L85.3","E03.9","J30.9","F25.9","G24.01","R06.02","E16.2","D61.818","R05.","R74.8","L91.0","L50.8","Z20.822","R07.89","R94.39","E16.1","N18.31","E21.3","E55.9","D64.9","F42.4","L90.5","D75.9","D69.6","D50.9","D70.9","D57.3","H40.003","H52.13","E56.9","R53.83","H90.3"],"date":["2021-03-25","2021-11-12","2021-09-03","2021-09-03","2021-10-22","2021-03-16","2021-03-16","2021-10-27","2021-03-16","2021-04-21","2021-04-21","2021-11-12","2021-10-27","2021-09-29","2021-06-29","2021-06-29","2021-10-21","2021-09-14","2021-10-19","2021-09-03","2021-08-25","2021-10-27","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-06","2021-08-06","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-05-19","2021-05-19","2021-06-29","2021-06-29","2021-08-05"],"priorHcc":[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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":[["","00591036901","LOXAPINE","5MG","67","Select","Select",""],["","13811071530","VENLAFAXINE","225MG ER","30","Select","Select",""],["","00832154011","HALOPERIDOL","5MG","16","Select","Select",""],["","69097082607","BENZTROPINE","0.5MG","90","Select","Select",""],["","65862059501","DIVALPROEX","500MG ER","180","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","-16","Select","Select",""],["","62175061846","PANTOPRAZOLE","20MG","-90","Select","Select",""],["","24208046325","LATANOPROST","0.01%","8","Select","Select",""],["","69097012203","TOPIRAMATE","25MG","180","Select","Select",""],["","53885065701","ONETOUCH","VERIO","1","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","50428016183","CVS","2000UNIT","120","Select","Select",""],["","59779027408","ASPIRIN","81MG","90","Select","Select",""],["","00378180310","LEVOTHYROXIN","50MCG","90","Select","Select",""],["","65862049001","QUETIAPINE","50MG","30","Select","Select",""],["","68462053670","IMIQUIMOD","5%","-24","Select","Select",""],["","43598043611","NITROGLYCERN","0.4MG","25","Select","Select",""],["","00003187957","DUODERM","6X6 X-TH","30","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","100","Select","Select",""],["","68180071909","AMLODIPINE","2.5MG","90","Select","Select",""],["","51672127401","BETAMETH","0.05%","45","Select","Select",""],["","00536100901","FERROUS","325MG","90","Select","Select",""],["","19515081852","FLULAVAL","2021-22","0","Select","Select",""],["","00591036901","LOXAPINE ","CAP 5MG","67","Select","Select",""],["","24208046325","LATANOPROST ","SOL 0.00005","8","Select","Select",""],["","69097082607","BENZTROPINE ","TAB 0.5MG","90","Select","Select",""],["","00054327099","FLUTICASONE ","SPR 50MCG","16","Select","Select",""],["","00832154011","HALOPERIDOL ","TAB 5MG","16","Select","Select",""],["","13811071530","VENLAFAXINE ","TAB 225MG ER","90","Select","Select",""],["","62175061846","PANTOPRAZOLE ","TAB 20MG","-90","Select","Select",""],["","00378180310","LEVOTHYROXIN ","TAB 50MCG","90","Select","Select",""],["","53885027210","ONETOUCH ","TES VERIO","100","Select","Select",""],["","59779027408","ASPIRIN ","CHW 81MG","90","Select","Select",""],["","68462053670","IMIQUIMOD ","CRE 0.05","-24","Select","Select",""],["","51672127401","BETAMETH ","CRE 0.0005","45","Select","Select",""],["","00054014025","ACARBOSE ","TAB 25MG","-45","Select","Select",""],["","65862059501","DIVALPROEX ","TAB 500MG ER","60","Select","Select",""],["","65862049101","QUETIAPINE ","TAB 100MG","-30","Select","Select",""],["","07610011210",""," ","90","Select","Select",""],["","69097012203","TOPIRAMATE ","TAB 25MG","60","Select","Select",""],["","38396031776","CVS ","MIS 33G","100","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","10006073038","MAG ","TAB 400MG","30","Select","Select",""],["","70377002911","ATORVASTATIN ","TAB 40MG","90","Select","Select",""],["","00536100901","FERROUS ","TAB 325MG","90","Select","Select",""],["","00003187957","DUODERM ","MIS 6X6 X-TH","30","Select","Select",""],["","43598043611","NITROGLYCERN ","SUB 0.4MG","25","Select","Select",""],["","19515081852","FLULAVAL ","INJ 2021-22","0","Select","Select",""],["","68180071909","AMLODIPINE ","TAB 2.5MG","90","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","",""],["Yes","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":""}]}]}