{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLEY J KINDER","gend":1,"add":"560 GOLD DR","city":"CHRISTIANSBURG","state":"VA","zip":24073,"dob":"1937-03-05","age":"","mstatus":"","insh":"900046859*01","cliId":"","pno":"540\/835-9821","cno":"540\/835-9821    ","email":"","ename":"","eno":"","pphy":"BROCHERO, ALFONSO MD","ppno":"540\/769-3964","pcpadd":"5115 BERNARD DR STE 301","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24018,"pcpcounty":"","pcpid":174951,"pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"DSNP","region":"Roanoke","aligned":"Y","ano":"540\/835-9821, ","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":["M19.272","M19.271","L60.0","L60.2","B35.1","I70.293","M25.551","W19.XXXA","M85.80","M19.90"],"date":["2021-03-27","2021-03-27","2021-03-27","2021-03-27","2021-03-27","2021-03-27","2021-04-16","2021-04-16","2021-04-16","2021-04-16"],"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":[["","6027754","JANUVIA","TAB 100MG","4","Select","Select",""],["","13668000901","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","60","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","378110505","GLIPIZIDE","TAB 5MG","60","Select","Select",""],["","45802015065","ALOGLIPTIN","TAB 25MG","14","Select","Select",""],["","88222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","31722052001","HYDRALAZINE","TAB 25MG","60","Select","Select",""],["","378395105","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","69238183107","LEVOTHYROXIN","TAB 50MCG","14","Select","Select",""],["","115180301","HYDROXYZ PAM","CAP 25MG","42","Select","Select",""],["","13668033005","TRAZODONE","TAB 50MG","4","Select","Select",""],["","169750111","NOVOLOG","INJ 100\/ML","10","Select","Select",""],["","378001805","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","378395105","ATORVASTATIN CALCIUM ","","7","Select","Select",""],["","31722052001","HYDRALAZINE HYDROCHLORIDE ","","28","Select","Select",""],["","69238183101","LEVOTHYROXINE SODIUM ","","14","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","","20","Select","Select",""],["","50111043302","TRAZODONE HYDROCHLORIDE","","30","Select","Select",""],["","169750111","NOVOLOG ","","10","Select","Select",""],["","378001805","METOPROLOL TARTRATE","","60","Select","Select",""],["","378110505","GLIPIZIDE ","","8","Select","Select",""],["","6027754","JANUVIA ","","4","Select","Select",""],["","67877056105","METFORMIN HYDROCHLORIDE","","60","Select","Select",""],["","13668000901","CITALOPRAM HYDROBROMIDE","","30","Select","Select",""],["","115180301","HYDROXYZINE PAMOATE","","42","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}