{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A JEFFREYS FERNANDES","gend":1,"add":"1940 SOUTH LAKELAND DR","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"2006-10-03","age":"","mstatus":"","insh":"900047934*01","cliId":"9GY6A56HM77","pno":"757\/327-3982","cno":"757\/327-3982","email":"","ename":"","eno":"","pphy":"FRIAS, ANGELINA MD","ppno":"757\/583-2181","pcpadd":"2203 E LITTLE CREEK RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":122721,"pcpname":"Roosevelt Family Practice","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/480-6482","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z94.0","Z79.899","I10.","D64.9","N25.81","N18.2","Z23.","D63.1","I12.9","R63.4","D84.821","Z68.54","Z82.49","Z71.3"],"date":["2021-09-29","2021-09-29","2021-08-04","2021-09-29","2021-09-29","2021-09-29","2021-06-09","2021-06-09","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2021-09-29"],"priorHcc":[null,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":[["","4025943","CELLCEPT","","180","Select","Select",""],["","904539561","FERREX 150","","60","Select","Select",""],["","60505014601","OMEPRAZOLE","","30","Select","Select",""],["","67877019805","AMLODIPINE BESYLATE","","60","Select","Select",""],["","469061773","PROGRAF ","","180","Select","Select",""],["","69452020713","CALCITRIOL","","30","Select","Select",""],["","55111046801","METOPROLOL SUCCINATE ER","","30","Select","Select",""],["","75834002001","VITAMIN D3","","4","Select","Select",""],["","00469065773","PROGRAF","","60","Select","Select",""],["","00054982831","PREDNISONE","5MG","30","Select","Select",""],["","00004025943","CELLCEPT                                                              ","CAP 250MG","180","Select","Select",""],["","69452020713","CALCITRIOL                                                            ","CAP 0.25MCG","30","Select","Select",""],["","55111046801","METOPROLOL SUCCINATE ER                                               ","TAB 100MG ER","30","Select","Select",""],["","00904539561","FERREX 150                                                            ","CAP 150MG","60","Select","Select",""],["","67877019805","AMLODIPINE BESYLATE                                                   ","TAB 5MG","60","Select","Select",""],["","60505014601","OMEPRAZOLE                                                            ","CAP 40MG","30","Select","Select",""],["","75834002001","VITAMIN D3                                                            ","CAP 50000UNT","4","Select","Select",""],["","00469061773","PROGRAF                                                               ","CAP 1MG","180","Select","Select",""],["","40093010231","VITAMIN D3 HIGH POTENCY                                               ","CAP 2000UNIT","12","Select","Select",""],["","00054982831","PREDNISONE                                                            ","TAB 5MG","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","",""],["Yes","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":""}]}]}