{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CLAIRA   M POKE","gend":1,"add":"122 GUILFORD ST","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1953-02-15","age":"","mstatus":"","insh":"900046423*01","cliId":"1J12F97FK98","pno":"434\/250-9677","cno":"434\/250-9677","email":"","ename":"","eno":"","pphy":"MILAM, JAMES MD","ppno":"434\/791-4122","pcpadd":"705 MAIN ST","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":140236,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"434\/250-9677","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/791-4126","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.00","I10.","E11.9","N18.31","E66.01","Z23.","Z00.00","E11.65","Z13.820","Z12.31","H40.1131","H40.1133","H43.813","H02.831","H02.834","H52.4","Z96.1"],"date":["2021-11-18","2021-11-18","2021-11-09","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01"],"priorHcc":[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":[["","11917007630","VITAMIN D","CAP 1000UNIT","90","Select","Select",""],["","363056314","ASPIRIN LOW","TAB 81MG EC","90","Select","Select",""],["","16729000517","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","363058714","ASPIRIN 81","TAB 81MG EC","90","Select","Select",""],["","68462016405","CARVEDILOL","TAB 12.5MG","180","Select","Select",""],["","65862020399","LOSARTAN POT","TAB 100MG","90","Select","Select",""],["","63304071890","DILTIAZEM","CAP 120MG ER","90","Select","Select",""],["","61314054701","LATANOPROST","SOL 0.00005","2","Select","Select",""],["","70010006510","METFORMIN","TAB 1000MG","-90","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","64980028005","GLIPIZIDE ER","TAB 5MG","90","Select","Select",""],["","65862020399","LOSARTAN POTASSIUM ","","90","Select","Select",""],["","63304071890","DILTIAZEM HYDROCHLORIDE ER","","90","Select","Select",""],["","363056314","ASPIRIN LOW DOSE","","90","Select","Select",""],["","11917007630","VITAMIN D ","","90","Select","Select",""],["","70010006510","METFORMIN HYDROCHLORIDE","","-90","Select","Select",""],["","16729018317","HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","65862020399","LOSARTAN POTASSIUM","","90","Select","Select",""],["","11917007548","CALCIUM 600+D","","60","Select","Select",""],["","00904323392","CALCIUM\/VITAMIN D","600-400","60","Select","Select",""],["","68462016405","CARVEDILOL                                                            ","TAB 12.5MG","180","Select","Select",""],["","00363056314","ASPIRIN LOW DOSE                                                      ","TAB 81MG EC","90","Select","Select",""],["","65862020399","LOSARTAN POTASSIUM                                                    ","TAB 100MG","90","Select","Select",""],["","63304071890","DILTIAZEM HYDROCHLORIDE ER                                            ","CAP 120MG ER","90","Select","Select",""],["","64980028005","GLIPIZIDE ER                                                          ","TAB 5MG","90","Select","Select",""],["","00363058714","ASPIRIN 81                                                            ","TAB 81MG EC","90","Select","Select",""],["","61314054701","LATANOPROST                                                           ","SOL 0.00005","2","Select","Select",""],["","70010006510","METFORMIN HYDROCHLORIDE                                               ","TAB 1000MG","90","Select","Select",""],["","00904323392","CALCIUM\/VITAMIN D                                                     ","TAB 600-400","60","Select","Select",""],["","16729000517","SIMVASTATIN                                                           ","TAB 20MG","90","Select","Select",""],["","16729018317","HYDROCHLOROTHIAZIDE                                                   ","TAB 25MG","90","Select","Select",""],["","11917007630","VITAMIN D                                                             ","CAP 1000UNIT","90","Select","Select",""],["","11917007548","CALCIUM 600+D                                                         ","","60","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":""}]}]}