{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA   A MAGARO","gend":1,"add":"3 WATER OAK CT","city":"WILLIAMSBURG","state":"VA","zip":"23188-9998","dob":"1944-07-23","age":"","mstatus":"","insh":"900047143*01","cliId":"5FD3NK1KV97","pno":"228\/760-1106","cno":"228\/760-1106","email":"","ename":"","eno":"","pphy":"MAYER, BRUCE MD","ppno":"757\/566-2045","pcpadd":"7151 RICHMOND ROAD SUITE 403","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":137637,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/741-2735","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G20.","R44.1","I63.9","M79.642","Z68.36","M19.042","M79.89","R20.0","R20.2","R53.1","G56.02","M79.671","B35.1","M20.11","M20.41","C50.411","C50.412","C79.51","Z17.0","M25.612","E11.9","G30.9","F02.80","M54.32","F41.8","I10.","Z85.3","Z91.81","Z86.718","Z79.82","Z79.01","Z79.899","Z00.00","C78.6","J98.11","K57.50","Z90.49","R53.81","Z51.11","N39.0","R07.9","C50.911","C50.912","K92.2","D62.","N17.9","C80.0","R41.0","R79.89","C50.919","R55.","Z71.89","Z51.5","I08.1","I27.20","C50.812","J90.","K57.10","K57.30"],"date":["2021-07-26","2021-07-02","2021-07-02","2021-04-14","2021-07-02","2021-04-02","2021-04-14","2021-04-14","2021-04-14","2021-08-22","2021-07-02","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-08-11","2021-08-11","2021-08-11","2021-08-11","2021-07-02","2021-07-02","2021-07-02","2021-07-26","2021-07-02","2021-08-22","2021-08-22","2021-07-02","2021-07-02","2021-06-15","2021-07-26","2021-08-22","2021-07-26","2021-07-02","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2021-08-04","2021-08-11","2021-08-11","2021-08-18","2021-07-26","2021-07-26","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-07-09","2021-07-09","2021-07-09","2021-07-09"],"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":[["","69097083305","SERTRALINE","TAB 25MG","90","Select","Select",""],["","65162083809","VALSARTAN","TAB 80MG","90","Select","Select",""],["","16714046801","CAPECITABINE","TAB 500MG","56","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","90","Select","Select",""],["","68180023209","FENOFIBRATE","TAB 160MG","90","Select","Select",""],["","69097083305","SERTRALINE HCL","","90","Select","Select",""],["","50458057930","XARELTO ","","90","Select","Select",""],["","51862085601","CARBIDOPA\/LEVODOPA ","","180","Select","Select",""],["","65162083809","VALSARTAN ","","90","Select","Select",""],["","45802046635","ECONAZOLE NITRATE","","30","Select","Select",""],["","51862085601","CARBIDOPA\/LEVODOPA","","135","Select","Select",""],["","50474080103","NEUPRO","","30","Select","Select",""],["","65162074510","PROMETHAZINE HCL","","20","Select","Select",""],["","00054418425","DEXAMETHASONE","4MG","10","Select","Select",""],["","67877056860","DRONABINOL","2.5MG","-60","Select","Select",""],["","50383066730","LIDOCAINE\/PRILOCAINE","2.5-2.5%","30","Select","Select",""],["","65862022701","LAMOTRIGINE","25MG","60","Select","Select",""],["","00143992801","CIPROFLOXACIN HYDROCHLORIDE","500MG","14","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","",""],["No","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":""}]}]}