{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" IRAIDA E RODRIGUEZ COLON","gend":1,"add":"9091 N CONGRESS STREET APT E40","city":"NEW MARKET","state":"VA","zip":"22844-9998","dob":"1966-07-22","age":"","mstatus":"","insh":"900047378*01","cliId":"","pno":"301\/756-5158","cno":"301\/756-5158, ","email":"","ename":"","eno":"","pphy":"LOVELACE, NANCE A DO","ppno":"540\/459-1340","pcpadd":"9166 N CONGRESS ST","pcpcity":"NEW MARKET","pcpstate":"VA","pcpzip":22844,"pcpcounty":"SHENANDOAH","pcpid":159063,"pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"DSNP","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","region":"NORTHERN\/ WINCHESTER","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.709"],"date":["2021-06-18"],"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":[["","65862052305","GABAPENTIN","","112","Select","Select",""],["","64980051401","TIMOLOL MALEATE","","10","Select","Select",""],["","00115165903","PROPRANOLOL HYDROCHLORIDE","","90","Select","Select",""],["","24208046325","LATANOPROST","","2","Select","Select",""],["","69238120502","BUPRENORPHINE","","4","Select","Select",""],["","43386009019","GAVILYTE-G","","4000","Select","Select",""],["","59651000305","OMEPRAZOLE DR","","90","Select","Select",""],["","16714023502","PENICILLIN V POTASSIUM","","-500","Select","Select",""],["","50111056101","TRAZODONE HYDROCHLORIDE","","90","Select","Select",""],["","00093005805","TRAMADOL HCL","","112","Select","Select",""],["","51991074890","DULOXETINE HYDROCHLORIDE","","60","Select","Select",""],["","00093081101","NORTRIPTYLINE HCL","","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":""}]}]}