{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY   M GARY","gend":1,"add":"2301 LANSING AVE APT B","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1948-06-19","age":"","mstatus":"","insh":"900048609*01","cliId":"2UK5Y44RD99","pno":"757\/393-0783","cno":"757\/393-0783","email":"","ename":"","eno":"","pphy":"YUNAS, MOHAMMAD MD","ppno":"393-6595","pcpadd":"3003 HIGH ST","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":200302,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/393-9584","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.01","I10.","E78.2","M79.7","M81.0","Z78.0","Z12.31","Z13.820","Z23."],"date":["2021-08-18","2021-10-20","2021-10-20","2021-08-18","2021-10-20","2021-09-14","2021-09-14","2021-09-14","2021-10-20"],"priorHcc":["",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":[["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","31722088390","ROSUVASTATIN CALCIUM","10MG","-18","Select","Select",""],["","69452015120","VITAMIN D","50000UNT","12","Select","Select",""],["","68382056501","METOPROLOL SUCCINATE ER","50MG ER","90","Select","Select",""],["","65862020399","LOSARTAN POTASSIUM","100MG","90","Select","Select",""],["","00406012305","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","5-325MG","30","Select","Select",""],["","51991064501","V-C FORTE","","90","Select","Select",""],["","65862020399","LOSARTAN POTASSIUM                                                    ","TAB 100MG","90","Select","Select",""],["","31722088390","ROSUVASTATIN CALCIUM                                                  ","TAB 10MG","18","Select","Select",""],["","69452015120","VITAMIN D                                                             ","CAP 50000UNT","12","Select","Select",""],["","51991064501","V-C FORTE                                                             ","CAP ","90","Select","Select",""],["","57237000511","FLUCONAZOLE                                                           ","TAB 150MG","1","Select","Select",""],["","68462015713","ONDANSETRON ODT                                                       ","TAB 4MG ODT","-3","Select","Select",""],["","45963067611","METOPROLOL SUCCINATE ER                                               ","TAB 50MG ER","90","Select","Select",""],["","65862032904","ALENDRONATE SODIUM                                                    ","TAB 70MG","12","Select","Select",""],["","00406012305","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 5-325MG","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","",""],["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":""}]}]}