{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY   A HAYES","gend":1,"add":"50 CAVALIER DRIVE APT # 203","city":"PETERSBURG","state":"VA","zip":"23805-9998","dob":"1950-03-13","age":"","mstatus":"","insh":"900046316*01","cliId":"4R11NC4FV16","pno":"804\/203-6195","cno":"804\/203-6195","email":"","ename":"","eno":"","pphy":"AHMED, IRSHAD MD","ppno":"804\/524-0524","pcpadd":"STE B 2801 BOULEVARD","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":23834,"pcpcounty":"","pcpid":119469,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/524-0520","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","E11.65","D64.9","M54.5","E66.8","Z68.30","Z12.11","Z79.899","M54.9","E11.9","J45.909","F41.9","E66.9","Z88.0","Z79.4","R10.9","M51.36","M75.102","Z12.31","M19.012","M25.412","M75.52","M25.512","R29.3","M25.612","R53.1","R68.89","Z72.89","Z87.891","M75.122","M75.82","M75.22","M25.511","M54.2","H25.13","H04.123","H35.413","Z23.","M19.011"],"date":["2021-11-04","2021-11-04","2021-02-25","2021-02-27","2021-07-01","2021-08-04","2021-08-04","2021-08-04","2021-02-27","2021-07-20","2021-06-28","2021-02-27","2021-06-28","2021-02-27","2021-06-28","2021-02-27","2021-02-27","2021-04-19","2021-03-04","2021-04-08","2021-04-08","2021-04-08","2021-09-09","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-04-26","2021-04-08","2021-04-08","2021-11-08","2021-06-28","2021-07-20","2021-07-20","2021-07-20","2021-09-09","2021-11-08"],"priorHcc":[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":[["","88221905","LANTUS SOLOS","INJ 100\/ML","-15","Select","Select",""],["","597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","6011231","JANUVIA","TAB 50MG","60","Select","Select",""],["","93720198","PRAVASTATIN","TAB 20MG","90","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","40","Select","Select",""],["","64980028101","GLIPIZIDE ER","TAB 10MG","180","Select","Select",""],["","378064205","PREDNISONE","TAB 20MG","7","Select","Select",""],["","76385011350","CARVEDILOL","TAB 25MG","180","Select","Select",""],["","68382097101","CHLORTHALID","TAB 50MG","90","Select","Select",""],["","8290320550","BD PEN NEEDL","MIS 32GX5\/32","-100","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","21","Select","Select",""],["","65162084009","VALSARTAN","TAB 320MG","90","Select","Select",""],["","6011231","JANUVIA ","","60","Select","Select",""],["","71093014105","METHOCARBAMOL ","","21","Select","Select",""],["","93720198","PRAVASTATIN SODIUM ","","90","Select","Select",""],["","65162084009","VALSARTAN ","","90","Select","Select",""],["","68382097101","CHLORTHALIDONE","","90","Select","Select",""],["","16571020106","DICLOFENAC SODIUM DR ","","40","Select","Select",""],["","8290320550","BD PEN NEEDLE\/NANO 2ND GEN\/32G X 5\/32\"","","-100","Select","Select",""],["","88221905","LANTUS SOLOSTAR ","","-15","Select","Select",""],["","50458014130","INVOKANA","","30","Select","Select",""],["","597015230","JARDIANCE ","","30","Select","Select",""],["","71093014105","METHOCARBAMOL","","21","Select","Select",""],["","16571020106","DICLOFENAC SODIUM DR","","40","Select","Select",""],["","00093720198","PRAVASTATIN SODIUM","","90","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","","15","Select","Select",""],["","00093005805","TRAMADOL HCL","","10","Select","Select",""],["","76385011350","CARVEDILOL                                                            ","TAB 25MG","180","Select","Select",""],["","00006011231","JANUVIA                                                               ","TAB 50MG","60","Select","Select",""],["","00597015230","JARDIANCE                                                             ","TAB 10MG","30","Select","Select",""],["","08290320550","BD PEN NEEDLE\/NANO 2ND GEN\/32G X 5\/32\"                                ","MIS 32GX5\/32","-100","Select","Select",""],["","68382097101","CHLORTHALIDONE                                                        ","TAB 50MG","90","Select","Select",""],["","00378064205","PREDNISONE                                                            ","TAB 20MG","7","Select","Select",""],["","71093014105","METHOCARBAMOL                                                         ","TAB 750MG","21","Select","Select",""],["","00093720198","PRAVASTATIN SODIUM                                                    ","TAB 20MG","90","Select","Select",""],["","50458014130","INVOKANA                                                              ","TAB 300MG","30","Select","Select",""],["","16571020106","DICLOFENAC SODIUM DR                                                  ","TAB 75MG DR","40","Select","Select",""],["","65162084009","VALSARTAN                                                             ","TAB 320MG","90","Select","Select",""],["","64980028101","GLIPIZIDE ER                                                          ","TAB 10MG","180","Select","Select",""],["","00088221905","LANTUS SOLOSTAR                                                       ","INJ 100\/ML","-15","Select","Select",""],["","00093005805","TRAMADOL HCL                                                          ","TAB 50MG","10","Select","Select",""],["","69097015907","MELOXICAM                                                             ","TAB 15MG","-30","Select","Select",""],["","59651000305","OMEPRAZOLE DR                                                         ","CAP 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":[[["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":""}]}]}