{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOANN GILES","gend":1,"add":"C\/O ORA HOBSON 128 MILLER LN","city":"CUMBERLAND","state":"VA","zip":"23040-9998","dob":"1961-07-10","age":"","mstatus":"","insh":"900047232*01","cliId":"2EP9EA7CA49","pno":"804\/492-9539","cno":"804\/492-9539","email":"","ename":"","eno":"","pphy":"RANSONE, STERLING N MD","ppno":"804\/776-8000","pcpadd":"16681 GENERAL PULLER HIGHWAY","pcpcity":"DELTAVILLE","pcpstate":"VA","pcpzip":23043,"pcpcounty":"","pcpid":118380,"pcpname":"Riverside Fishing Bay Family Practice","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/776-6211","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H40.1134","H25.13"],"date":["2021-11-05","2021-11-05"],"priorHcc":[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":[["","10370083105","DILTIAZEM","CAP 240MG ER","30","Select","Select",""],["","23921110","COMBIGAN","SOL 0.2\/0.5%","10","Select","Select",""],["","61314054701","LATANOPROST","SOL 0.00005","2","Select","Select",""],["","68180051902","LISINOP\/HCTZ","TAB 20-12.5","30","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","60505257908","ATORVASTATIN CALCIUM ","","30","Select","Select",""],["","68180051902","LISINOPRIL\/HYDROCHLOROTHIAZIDE","","30","Select","Select",""],["","10370083105","DILTIAZEM HYDROCHLORIDE ER","","30","Select","Select",""],["","49884083111","DILTIAZEM CD","","30","Select","Select",""],["","60505257908","ATORVASTATIN CALCIUM","","30","Select","Select",""],["","60505257908","ATORVASTATIN CALCIUM                                                  ","TAB 20MG","30","Select","Select",""],["","10370083105","DILTIAZEM HYDROCHLORIDE ER                                            ","CAP 240MG ER","30","Select","Select",""],["","49884083111","DILTIAZEM CD                                                          ","CAP 240MG CD","30","Select","Select",""],["","61314054701","LATANOPROST                                                           ","SOL 0.00005","2","Select","Select",""],["","68180051902","LISINOPRIL\/HYDROCHLOROTHIAZIDE                                        ","TAB 20-12.5","30","Select","Select",""],["","00023921110","COMBIGAN                                                              ","SOL 0.2\/0.5%","10","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","",""],["Yes","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":""}]}]}