{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUSTIN   W THURMAN","gend":0,"add":"5439 TIMBERWOLF CIR","city":"CAVE SPRING","state":"VA","zip":"24018-9998","dob":"1987-04-27","age":"","mstatus":"","insh":"900047020*01","cliId":"4Y38UR2FR45","pno":"540\/989-8371","cno":"540\/989-8371","email":"","ename":"","eno":"","pphy":"JAEGER, ANNE M MD","ppno":"540\/345-4946","pcpadd":"SUITE 201 4461 STARKEY RD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24018,"pcpcounty":"","pcpid":159333,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/343-7693","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I51.7","F90.0","Z23.","F41.9","F32.9"],"date":["2021-03-10","2021-09-24","2021-03-24","2021-09-24","2021-09-24"],"priorHcc":["",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":[["","43547030303","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","70010004301","METHYLPHENID","TAB 20MG ER","30","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","10702010101","METHYLPHENIDATE HYDROCHLORIDE","","60","Select","Select",""],["","70010004301","METHYLPHENIDATE HYDROCHLORIDE ER","","30","Select","Select",""],["","43598056601","FLUOXETINE HYDROCHLORIDE","","-45","Select","Select",""],["","50111064801","FLUOXETINE HCL","","30","Select","Select",""],["","43547030303","ARIPIPRAZOLE                                                          ","TAB 5MG","30","Select","Select",""],["","10702010101","METHYLPHENIDATE HYDROCHLORIDE                                         ","TAB 10MG","60","Select","Select",""],["","70010004301","METHYLPHENIDATE HYDROCHLORIDE ER                                      ","TAB 20MG ER","30","Select","Select",""],["","50111064801","FLUOXETINE HCL                                                        ","CAP 20MG","30","Select","Select",""],["","43598056601","FLUOXETINE HYDROCHLORIDE                                              ","TAB 20MG","-45","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":""}]}]}