{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGEL   M COLEMAN","gend":1,"add":"500 AVONDALE DR","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1988-03-25","age":"","mstatus":"","insh":"900047787*01","cliId":"6J39DV9TJ48","pno":"434\/797-2112","cno":"434\/797-2112","email":"","ename":"","eno":"","pphy":"DANG, ANNA DO","ppno":"434\/857-3600","pcpadd":"414 PARK AVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":182209,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CHARLOTTESVILLE WESTERN","aligned":"Y","ano":"Non-DSNP","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":["I10.","Z00.00","Z23.","E66.01","H60.90"],"date":["2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07"],"priorHcc":[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":[["","68180072003","AMLODIPINE BESYLATE","","90","Select","Select",""],["","67877025145","TRIAMCINOLONE ACETONIDE","","454","Select","Select",""],["","93321992","KETOCONAZOLE","","60","Select","Select",""],["","69097083512","SERTRALINE HYDROCHLORIDE","","60","Select","Select",""],["","43547030503","ARIPIPRAZOLE","","30","Select","Select",""],["","47469007064","","","30","Select","Select",""],["","69097082707","BENZTROPINE MESYLATE","","180","Select","Select",""],["","00093321992","KETOCONAZOLE                                                          ","CRE 0.02","60","Select","Select",""],["","67877025145","TRIAMCINOLONE ACETONIDE                                               ","CRE 0.001","454","Select","Select",""],["","69097083512","SERTRALINE HYDROCHLORIDE                                              ","TAB 100MG","60","Select","Select",""],["","43547030503","ARIPIPRAZOLE                                                          ","TAB 15MG","30","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE                                                   ","TAB 5MG","90","Select","Select",""],["","69097082707","BENZTROPINE MESYLATE                                                  ","TAB 1MG","180","Select","Select",""],["","47469007064","                                                                      "," ","30","Select","Select",""],["","24208063110","NEOMYCIN\/POLYMYXIN\/HC                                                 ","SOL 1% OTIC","10","Select","Select",""],["","51672135708","FLUOCINOLONE ACETONIDE SCALP                                          ","OIL 0.01% SC","118","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":""}]}]}