{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN   P NUNLEY","gend":0,"add":"10 HUNGRY HOLLOW RD","city":"BLAND","state":"VA","zip":"24315-9998","dob":"1977-08-07","age":"","mstatus":"","insh":"900047451*01","cliId":"4DV2HY8YC06","pno":"276\/928-1973","cno":"276\/928-1973","email":"","ename":"","eno":"","pphy":"CREWS, MICHAEL O DO","ppno":"540\/688-4331","pcpadd":"12301 GRAPEFIELD RD","pcpcity":"BASTIAN","pcpstate":"VA","pcpzip":24314,"pcpcounty":"","pcpid":107110,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"276\/730-5704","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H72.01","J34.89","F11.20","F13.20","F12.11","F10.11","F17.200","F51.01","I10.","K21.9","R35.1","Z72.0","Z79.899","F11.10","Z79.890"],"date":["2021-04-15","2021-04-15","2021-09-29","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-08","2021-09-29","2021-05-20","2021-05-20"],"priorHcc":["","",null,null,null,null,null,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":[["","12496120803","SUBOXONE","MIS 8-2MG","56","Select","Select",""],["","60505036301","OFLOXACIN","DRO 0.3%OTIC","5","Select","Select",""],["","47781035703","BUPRENORPHINE HYDROCHLORIDE\/NALOXONE HYDROCHLORIDE","","56","Select","Select",""],["","60505036301","OFLOXACIN ","","5","Select","Select",""],["","13668000805","ZOLPIDEM TARTRATE","","30","Select","Select",""],["","68180098003","LISINOPRIL","","30","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","","30","Select","Select",""],["","57237001401","TAMSULOSIN HYDROCHLORIDE","","30","Select","Select",""],["","00536589688","NICOTINE TRANSDERMAL SYSTEM","","28","Select","Select",""],["","12496120803","SUBOXONE                                                              ","MIS 8-2MG","56","Select","Select",""],["","60505036301","OFLOXACIN                                                             ","DRO 0.3%OTIC","5","Select","Select",""],["","47781035703","BUPRENORPHINE HYDROCHLORIDE\/NALOXONE HYDROCHLORIDE                    ","MIS 8-2MG","56","Select","Select",""],["","00536589688","NICOTINE TRANSDERMAL SYSTEM                                           ","DIS 21MG\/24H","28","Select","Select",""],["","68180098003","LISINOPRIL                                                            ","TAB 10MG","30","Select","Select",""],["","13668000805","ZOLPIDEM TARTRATE                                                     ","TAB 10MG","30","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE                                                   ","TAB 10MG","30","Select","Select",""],["","57237001401","TAMSULOSIN HYDROCHLORIDE                                              ","CAP 0.4MG","30","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","",""],["No","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":""}]}]}