{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIE MOORE","gend":1,"add":"10916 NOY AND PEARLIE ROAD","city":"POUND","state":"VA","zip":"24279-9998","dob":"1941-04-05","age":"","mstatus":"","insh":"900047984*01","cliId":"8TY3DM9XG02","pno":"276\/219-0925","cno":"276\/219-0925","email":"","ename":"","eno":"","pphy":"WHEATLEY, MICHAEL W MD","ppno":"276\/328-7071","pcpadd":"417 W MAIN ST","pcpcity":"WISE","pcpstate":"VA","pcpzip":24293,"pcpcounty":"","pcpid":171020,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/328-6082","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","I47.1","R53.81","R53.83","R00.2","R63.4","E11.42","M25.512","G89.29","R14.0","Z00.00","M17.0","F33.41","M25.511","R60.0","E11.9","H40.013","H02.032","M81.8","E78.2","K21.9","M15.9","F41.1","R60.9","Z23.","R10.13","I87.2","M79.89","M19.072"],"date":["2021-11-03","2021-11-12","2021-10-15","2021-10-15","2021-10-26","2021-11-17","2021-11-03","2021-09-30","2021-09-30","2021-11-03","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2021-08-10","2021-08-10","2021-08-10","2021-09-30","2021-10-12","2021-10-12","2021-10-12","2021-08-05","2021-08-05","2021-11-03","2021-11-03","2021-11-03","2021-05-03","2021-05-03"],"priorHcc":[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,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":[["","68462039610","OMEPRAZOLE","","30","Select","Select",""],["","29300012410","MELOXICAM ","","45","Select","Select",""],["","603548521","PROPRANOLOL HCL ","","180","Select","Select",""],["","65862012601","TORSEMIDE ","","30","Select","Select",""],["","70436001002","BUPROPION HYDROCHLORIDE ER (XL) ","","30","Select","Select",""],["","16729021810","CLOPIDOGREL","","90","Select","Select",""],["","57237017190","ROSUVASTATIN CALCIUM ","","90","Select","Select",""],["","56151146004","TRUE METRIX BLOOD GLUCOSETEST STRIPS","","100","Select","Select",""],["","65862001305","SERTRALINE HYDROCHLORIDE","","180","Select","Select",""],["","00603548521","PROPRANOLOL HCL","","180","Select","Select",""],["","29300012410","MELOXICAM","","45","Select","Select",""],["","65862012601","TORSEMIDE","","30","Select","Select",""],["","70436001002","BUPROPION HYDROCHLORIDE ER (XL)","","30","Select","Select",""],["","70010049105","METFORMIN HYDROCHLORIDE ER","","180","Select","Select",""],["","68001033203","LISINOPRIL","","90","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIPS","","100","Select","Select",""],["","57237017190","ROSUVASTATIN CALCIUM","","90","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX BLOOD GLUCOSE MONITORING SYSTEM","","1","Select","Select",""],["","16729022516","SPIRONOLACTONE","","45","Select","Select",""],["","00310621030","FARXIGA","10MG","30","Select","Select",""],["","50742061610","METOPROLOL SUCCINATE ER","50MG ER","30","Select","Select",""],["","68462039610","OMEPRAZOLE                                                            ","CAP 20MG","30","Select","Select",""],["","16729021810","CLOPIDOGREL                                                           ","TAB 75MG","90","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX BLOOD GLUCOSE MONITORING SYSTEM                   ","KIT VERIO FL","1","Select","Select",""],["","00603548521","PROPRANOLOL HCL                                                       ","TAB 60MG","180","Select","Select",""],["","65862012601","TORSEMIDE                                                             ","TAB 10MG","30","Select","Select",""],["","65862001305","SERTRALINE HYDROCHLORIDE                                              ","TAB 100MG","180","Select","Select",""],["","70436001002","BUPROPION HYDROCHLORIDE ER (XL)                                       ","TAB 150MG XL","30","Select","Select",""],["","56151146004","TRUE METRIX BLOOD GLUCOSETEST STRIPS                                  ","TES GLUCOSE","-100","Select","Select",""],["","57237017190","ROSUVASTATIN CALCIUM                                                  ","TAB 40MG","90","Select","Select",""],["","16729022516","SPIRONOLACTONE                                                        ","TAB 25MG","45","Select","Select",""],["","68382005005","MELOXICAM                                                             ","TAB 7.5MG","45","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIPS                                            ","TES VERIO","100","Select","Select",""],["","13107003105","MIRTAZAPINE                                                           ","TAB 15MG","30","Select","Select",""],["","68462063801","NITROGLYCERIN                                                         ","SUB 0.3MG","100","Select","Select",""],["","00310621030","FARXIGA                                                               ","TAB 10MG","30","Select","Select",""],["","31722071310","PANTOPRAZOLE SODIUM                                                   ","TAB 40MG","30","Select","Select",""],["","50742061610","METOPROLOL SUCCINATE ER                                               ","TAB 50MG ER","30","Select","Select",""],["","70010049105","METFORMIN HYDROCHLORIDE ER                                            ","TAB 500MG ER","180","Select","Select",""],["","68001033203","LISINOPRIL                                                            ","TAB 2.5MG","90","Select","Select",""],["","24979002702","DILTIAZEM HYDROCHLORIDE ER                                            ","CAP 180MG ER","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","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":""}]}]}