{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL   W BRYANT","gend":0,"add":"3011 BONSACK ST","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1956-06-17","age":"","mstatus":"","insh":"900047275*01","cliId":"6Q85HE6NP50","pno":"434\/258-5418","cno":"434\/258-5418","email":"","ename":"","eno":"","pphy":"BRENNAN, ROBERT MD","ppno":"434\/947-3944","pcpadd":"2215 LANDOVER PL","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24501,"pcpcounty":"LYNCHBURG CITY","pcpid":105594,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","region":"CHARLOTTESVILLE WESTERN","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.8","Z71.3","I10.","E78.2","G47.33","E66.01","D64.9","Z72.0","J44.9","M79.2","G47.411","K21.9","E11.65","R35.89","R63.1","Z23.","Z79.4"],"date":["2021-10-25","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2021-10-25","2021-06-21","2021-09-28","2021-06-21","2021-10-18","2021-10-18","2021-10-18","2021-10-25","2021-10-25"],"priorHcc":[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":[["","68180098003","LISINOPRIL","","28","Select","Select",""],["","16729009016","FINASTERIDE","","28","Select","Select",""],["","57237010199","METOPROLOL TARTRATE","","56","Select","Select",""],["","61442012101","FAMOTIDINE","","30","Select","Select",""],["","00406114401","METHYLPHENIDATE HYDROCHLORIDE","","90","Select","Select",""],["","65862019405","FLUOXETINE HYDROCHLORIDE","","30","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","","8","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT","","4","Select","Select",""],["","00536589688","NICOTINE TRANSDERMAL SYSTEM","","28","Select","Select",""],["","65862098799","POTASSIUM CHLORIDE ER","","28","Select","Select",""],["","16729021816","CLOPIDOGREL","","28","Select","Select",""],["","67877022310","GABAPENTIN","","112","Select","Select",""],["","00378395305","ATORVASTATIN CALCIUM","","28","Select","Select",""],["","16729041401","DOXAZOSIN MESYLATE","","28","Select","Select",""],["","00169406013","VICTOZA","","9","Select","Select",""],["","31722070110","LOSARTAN POTASSIUM","","25","Select","Select",""],["","63868036336","QC ASPIRIN LOW DOSE","","28","Select","Select",""],["","00904675180","ASPIRIN LOW DOSE","","28","Select","Select",""],["","00904582460","VITAMIN D3","1000UNIT","28","Select","Select",""],["","08881501368","MONOJECT TUBERCULIN SYRINGE\/DETACH NEEDLE\/1ML\/27G X 1\/2\"","27GX1\/2\"","44","Select","Select",""],["","08290309623","BD 1ML TUBERCULIN SYRINGEDETACHABLE NEEDLE SLIP TIP 27GX1\/2\"","27GX1\/2\"","44","Select","Select",""],["","00088222033","LANTUS","100\/ML","60","Select","Select",""],["","68180098003","LISINOPRIL                                                            ","TAB 10MG","28","Select","Select",""],["","65862019405","FLUOXETINE HYDROCHLORIDE                                              ","CAP 40MG","28","Select","Select",""],["","00378395305","ATORVASTATIN CALCIUM                                                  ","TAB 80MG","28","Select","Select",""],["","00169406013","VICTOZA                                                               ","INJ 18MG\/3ML","27","Select","Select",""],["","61442012101","FAMOTIDINE                                                            ","TAB 20MG","30","Select","Select",""],["","00406114401","METHYLPHENIDATE HYDROCHLORIDE                                         ","TAB 10MG","90","Select","Select",""],["","00904675180","ASPIRIN LOW DOSE                                                      ","TAB 81MG EC","28","Select","Select",""],["","67877022310","GABAPENTIN                                                            ","CAP 300MG","-112","Select","Select",""],["","80681016900","VITAMIN D3                                                            ","TAB 25MCG","28","Select","Select",""],["","16729009016","FINASTERIDE                                                           ","TAB 5MG","28","Select","Select",""],["","65862098799","POTASSIUM CHLORIDE ER                                                 ","TAB 10MEQ ER","28","Select","Select",""],["","57237010199","METOPROLOL TARTRATE                                                   ","TAB 50MG","56","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA                                                 ","AER HFA","8","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT                                                      ","SPR 2.5MCG","4","Select","Select",""],["","00536589688","NICOTINE TRANSDERMAL SYSTEM                                           ","DIS 21MG\/24H","28","Select","Select",""],["","16729041401","DOXAZOSIN MESYLATE                                                    ","TAB 2MG","28","Select","Select",""],["","63868036336","QC ASPIRIN LOW DOSE                                                   ","TAB 81MG EC","28","Select","Select",""],["","16729021816","CLOPIDOGREL                                                           ","TAB 75MG","28","Select","Select",""],["","31722070110","LOSARTAN POTASSIUM                                                    ","TAB 50MG","28","Select","Select",""],["","08881501368","MONOJECT TUBERCULIN SYRINGE\/DETACH NEEDLE\/1ML\/27G X 1\/2\"              ","MIS 27GX1\/2\"","44","Select","Select",""],["","00088222033","LANTUS                                                                ","INJ 100\/ML","-10","Select","Select",""],["","67877056110","METFORMIN HYDROCHLORIDE                                               ","TAB 500MG","60","Select","Select",""],["","08290309623","BD 1ML TUBERCULIN SYRINGEDETACHABLE NEEDLE SLIP TIP 27GX1\/2\"          ","MIS 27GX1\/2\"","44","Select","Select",""],["","08290320109","BD PEN NEEDLE\/SHORT\/ULTRA-FINE\/31G X 8MM                              ","MIS 31GX8MM","100","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER                                                    ","CAP HANDIHLR","30","Select","Select",""],["","31604001870","VITAMIN D                                                             ","TAB 1000UNIT","30","Select","Select",""],["","08290328411","BD INSULIN SYRINGE ULTRA-FINE\/1ML\/30G X 12.7MM                        ","MIS 1ML\/30G","100","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":""}]}]}