{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA   M BALLARD","gend":1,"add":"26013 POPE STATION ROAD","city":"CAPRON","state":"VA","zip":"23829-9998","dob":"1958-06-22","age":"","mstatus":"","insh":"900047073*01","cliId":"8N83CD3AC78","pno":"757\/743-8096","cno":"757\/743-8096","email":"","ename":"","eno":"","pphy":"RISSER, ANDREYA MD","ppno":"804\/717-5300","pcpadd":"STE 117 11601 IRONBRIDGE RD","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":23831,"pcpcounty":"","pcpid":105605,"pcpname":"AYLETT MEDICAL CENTER","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/748-7269","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z85.3","Z90.13","N63.0","N63.11","R23.4","Z90.3","C50.511","E11.65","E78.5","I10.","Z01.89","Z00.00","Z68.41","E66.01","F39.","Z88.9","G62.9","Z71.89","M47.12","I42.8","Z90.11","Z23.","E11.9","Z68.39","E66.9","G47.33"],"date":["2021-11-19","2021-10-21","2021-06-24","2021-05-18","2021-11-19","2021-05-18","2021-06-22","2021-10-21","2021-10-21","2021-10-21","2021-07-01","2021-06-21","2021-06-21","2021-06-21","2021-10-21","2021-06-21","2021-10-21","2021-06-21","2021-07-13","2021-10-05","2021-11-19","2021-10-21","2021-10-21","2021-10-21","2021-10-21","2021-09-02"],"priorHcc":[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":[["","597015230","JARDIANCE","TAB 10MG","60","Select","Select",""],["","45802057178","FEXOFENADINE","TAB 180MG","180","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","200","Select","Select",""],["","41167412003","ALLEGRA ALRG","TAB 180MG","180","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","597015230","JARDIANCE ","","90","Select","Select",""],["","45802057178","FEXOFENADINE HYDROCHLORIDE","","180","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIPS","","200","Select","Select",""],["","41167412003","ALLEGRA ALLERGY ","","180","Select","Select",""],["","68180051802","LISINOPRIL\/HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","16729003410","LETROZOLE ","","90","Select","Select",""],["","41167412003","ALLEGRA ALLERGY","","180","Select","Select",""],["","16729003410","LETROZOLE","","90","Select","Select",""],["","00378718505","METFORMIN HYDROCHLORIDE","","180","Select","Select",""],["","55111012305","ATORVASTATIN CALCIUM","","90","Select","Select",""],["","69097084905","ESCITALOPRAM OXALATE","","90","Select","Select",""],["","41167412003","ALLEGRA ALLERGY                                                       ","TAB 180MG","180","Select","Select",""],["","00597015230","JARDIANCE                                                             ","TAB 10MG","60","Select","Select",""],["","68180051802","LISINOPRIL\/HYDROCHLOROTHIAZIDE                                        ","TAB 10-12.5","90","Select","Select",""],["","65162010250","GABAPENTIN                                                            ","CAP 300MG","30","Select","Select",""],["","69097084905","ESCITALOPRAM OXALATE                                                  ","TAB 20MG","90","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIPS                                            ","TES VERIO","200","Select","Select",""],["","45802057178","FEXOFENADINE HYDROCHLORIDE                                            ","TAB 180MG","180","Select","Select",""],["","16729003410","LETROZOLE                                                             ","TAB 2.5MG","90","Select","Select",""],["","55111012305","ATORVASTATIN CALCIUM                                                  ","TAB 40MG","90","Select","Select",""],["","00378718505","METFORMIN HYDROCHLORIDE                                               ","TAB 500MG","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":[[["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":""}]}]}