{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ISABEL   P ALBERT","gend":1,"add":"10705 SQUAW VALLEY PL","city":"GLEN ALLEN","state":"VA","zip":"23060-9998","dob":"1924-08-20","age":"","mstatus":"","insh":"900046633*01","cliId":"5C24WH3KQ63","pno":"717\/891-7265","cno":"717\/891-7265","email":"","ename":"","eno":"","pphy":"ADAMS, HELEN MD","ppno":"804\/346-1780","pcpadd":"SUITE 150 4900 COX ROAD","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":"23060-9998","pcpcounty":"","pcpid":147264,"pcpname":"VPI - Innsbrook Primary Care","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"717\/309-9038","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.","E78.00","Z95.2","Z79.01","I48.20","Z87.448","R05."],"date":["2021-05-05","2021-05-05","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-07-14"],"priorHcc":["","","","","","",""]}},{"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":[["","00003089321","ELIQUIS ","2.5MG","180","Select","Select",""],["","69315011710","FUROSEMIDE ","40MG","180","Select","Select",""],["","68462026290","ROSUVASTATIN ","10MG","90","Select","Select",""],["","45963067696","METOPROLOL ","50MG ER","180","Select","Select",""],["","50742061610","METOPROL ","50MG ER","180","Select","Select",""],["","69315011710","","40MG","180","Select","Select",""],["","45963067696","METOPROLOL","50MG ER","180","Select","Select",""],["","69315011710","FUROSEMIDE","40MG","180","Select","Select",""],["","68462026290","ROSUVASTATIN","10MG","90","Select","Select",""],["","00003089321","ELIQUIS","2.5MG","180","Select","Select",""],["","50742061610","METOPROL","50MG ER","180","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","",""],["No","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":""}]}]}