{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BERTHA   M WILSON","gend":1,"add":"1853 HICKORY HILL ROAD","city":"SAINT STEPHENS CHURCH","state":"VA","zip":"23148-9998","dob":"1950-12-02","age":"","mstatus":"","insh":"900047509*01","cliId":"3WC6AU1GF44","pno":"910\/778-4552","cno":"910\/778-4552","email":"","ename":"","eno":"","pphy":"GWATHMEY, PAMELA L MD","ppno":"804\/769-0103","pcpadd":"142 SMITHFIELD RD","pcpcity":"SAINT STEPHENS CHURCH","pcpstate":"VA","pcpzip":23148,"pcpcounty":"","pcpid":108995,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/769-0103","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","E78.2","I10.","Z12.31"],"date":["2021-05-24","2021-05-24","2021-05-24","2021-06-09"],"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":[["","24208046325","LATANOPROST ","0.01%","8","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","90","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","90","Select","Select",""],["","76385011250","CARVEDILOL ","12.5MG","180","Select","Select",""],["","13668010390","DONEPEZIL ","10MG","90","Select","Select",""],["","65162083909","VALSARTAN ","160MG","90","Select","Select",""],["","64980051405","TIMOLOL ","0.5% OP","5","Select","Select",""],["","16729018201","","12.5MG","90","Select","Select",""],["","24208046325","LATANOPROST","0.01%","8","Select","Select",""],["","76385011250","CARVEDILOL","12.5MG","180","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","90","Select","Select",""],["","64980051405","TIMOLOL","0.5% OP","5","Select","Select",""],["","13668010390","DONEPEZIL","10MG","90","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","90","Select","Select",""],["","65162083909","VALSARTAN","160MG","90","Select","Select",""],["","70461012103","FLUAD","2021-22","0","Select","Select",""],["","70461012103","FLUAD ","INJ 2021-22","0","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":""}]}]}