{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHERYL   H CANTY","gend":1,"add":"301 DWIGHT DR","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1956-05-04","age":"","mstatus":"","insh":"900047336*01","cliId":"3YP2DM1DT14","pno":"757\/818-7038","cno":"757\/818-7038","email":"","ename":"","eno":"","pphy":"ANGLIN, VICTOR TEODORO MD","ppno":"757\/738-1225","pcpadd":"3537 AIRLINE BLVD STE 1","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23701,"pcpcounty":"PORTSMOUTH CITY","pcpid":207840,"pcpname":"AIRLINE BOULEVARD MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICARE","lob":"DSNP","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","region":"TIDEWATER","pcpfaxno":"757\/448-1037","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":[],"date":[],"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":[["","68180021709","LOSARTAN POTASSIUM\/HYDROCHLOROTHIAZIDE","","90","Select","Select",""],["","51991074890","DULOXETINE HYDROCHLORIDE","","90","Select","Select",""],["","68382075810","METFORMIN HYDROCHLORIDE","","180","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","","60","Select","Select",""],["","00093220305","METOCLOPRAMIDE HYDROCHLORIDE","","30","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","","90","Select","Select",""],["","65862039010","ONDANSETRON ODT","","30","Select","Select",""],["","65862022701","LAMOTRIGINE","","90","Select","Select",""],["","69097094312","GABAPENTIN","","180","Select","Select",""],["","49483048112","ASPIRIN LOW DOSE","81MG EC","90","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":""}]}]}