{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS ALLEN JR","gend":0,"add":"4816 TANNER TOWN RODE","city":"BRODNAX","state":"VA","zip":"23920-9998","dob":"1934-02-13","pno":"434\/532-3942","cno":"434\/532-3942","email":"","pphy":"POWERS III, GRAHAM H MD","ppno":"","pcpadd":"514 W ATLANTIC ST","pcpcity":"SOUTH HILL","pcpstate":"VA","pcpzip":23970,"pcpcounty":"","pcpid":210251,"pcpname":"","insh":"900046349*01","cliId":"8A70PY1FC27","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/447-2240","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.119","E11.22","N18.31","E78.5","E55.9"],"date":["2021-02-05","2021-10-25","2021-10-25","2021-07-20","2021-07-20"],"priorHcc":[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":[["","00169643810","LEVEMIR","FLEXTOUC","15","Select","Select",""],["","57237012301","WARFARIN","4MG","100","Select","Select",""],["","60505132305","PRAVASTATIN","80MG","10","Select","Select",""],["","00169431413","RYBELSUS","14MG","90","Select","Select",""],["","68645054154","FINASTERIDE","5MG","90","Select","Select",""],["","42806031250","DOXYCYCL","100MG","20","Select","Select",""],["","43547040111","FUROSEMIDE","20MG","90","Select","Select",""],["","58160081912","SHINGRIX","50\/0.5ML","-1","Select","Select",""],["","65862014305","CARVEDILOL","6.25MG","180","Select","Select",""],["","58160084252","BOOSTRIX","","0","Select","Select",""],["","00169300425","NOVOLIN","100 UNIT","15","Select","Select",""],["","68645052254","SERTRALINE","50MG","90","Select","Select",""],["","29300022019","MONTELUKAST","10MG","30","Select","Select",""],["","70069042101","LATANOPROST","0.01%","2","Select","Select",""],["","65162067684","AZELASTINE","0.10%","30","Select","Select",""],["","31722070090","LOSARTAN","25MG","90","Select","Select",""],["","70069005101","DORZOL\/TIMOL","22.3-6.8","10","Select","Select",""],["","60505132305","PRAVASTATIN ","TAB 80MG","10","Select","Select",""],["","57237012301","WARFARIN ","TAB 4MG","100","Select","Select",""],["","00169430713","RYBELSUS ","TAB 7MG","30","Select","Select",""],["","43547040111","FUROSEMIDE ","TAB 20MG","90","Select","Select",""],["","58160084252","BOOSTRIX ","INJ ","0","Select","Select",""],["","00169643810","LEVEMIR ","INJ FLEXTOUC","15","Select","Select",""],["","00169300425","NOVOLIN ","INJ 100 UNIT","-15","Select","Select",""],["","58160081912","SHINGRIX ","INJ 50\/0.5ML","-1","Select","Select",""],["","68645054154","FINASTERIDE ","TAB 5MG","90","Select","Select",""],["","68382009305","CARVEDILOL ","TAB 6.25MG","180","Select","Select",""],["","68645052254","SERTRALINE ","TAB 50MG","90","Select","Select",""],["","42806031250","DOXYCYCL ","TAB 100MG","20","Select","Select",""],["","70069042101","LATANOPROST ","SOL 0.00005","2","Select","Select",""],["","70069005101","DORZOL\/TIMOL ","SOL 22.3-6.8","10","Select","Select",""],["","29300022019","MONTELUKAST ","TAB 10MG","30","Select","Select",""],["","31722070090","LOSARTAN ","TAB 25MG","90","Select","Select",""],["","65162067684","AZELASTINE ","SPR 0.001","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","",""],["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":""}]}]}