{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFFREY   L LANE","gend":0,"add":"311 MAIN ST","city":"NEWPORT NEWS","state":"VA","zip":"23601-9998","dob":"1966-01-09","age":"","mstatus":"","insh":"900048616*01","cliId":"3D90X12UP00","pno":"757\/596-6010","cno":"757\/596-6010","email":"","ename":"","eno":"","pphy":"JERNIGAN, JAMES E MD","ppno":"804\/730-1111","pcpadd":"7255 HANOVER GREEN DR","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":23111,"pcpcounty":"","pcpid":135732,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"757\/596-6010","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/730-9764","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","Z23.","E11.9","I10.","R53.1","Z74.3","F23.","E86.0","E83.42","R11.0","M54.5","H91.93","R11.2","R42.","K86.1","N32.89","F20.89"],"date":["2021-11-11","2021-09-24","2021-09-24","2021-09-24","2021-08-04","2021-08-04","2021-11-20","2021-08-04","2021-08-04","2021-08-04","2021-07-06","2021-07-06","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2021-11-11"],"priorHcc":[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":[["","68382007901","","5MG","62","Select","Select",""],["","00006027754","JANUVIA","100MG","31","Select","Select",""],["","47335090588","QUETIAPINE","200MG","31","Select","Select",""],["","62107005110","TACTINAL","500MG","60","Select","Select",""],["","00378086005","CLOZAPINE","100MG","14","Select","Select",""],["","58487003711","VITAMIN","2000UNIT","31","Select","Select",""],["","53885024450","ONETOUCH","ULTRA","50","Select","Select",""],["","69315013710","BENZTROPINE","1MG","31","Select","Select",""],["","08222095435","ULTIGUARD","32GX4MM","100","Select","Select",""],["","45802086803","POLYETH","3350 NF","510","Select","Select",""],["","00088221905","LANTUS","100\/ML","3","Select","Select",""],["","68382007901","HALOPERIDOL","5MG","62","Select","Select",""],["","56151034101","TRUPLUS","28G","100","Select","Select",""],["","00003089421","ELIQUIS","5MG","62","Select","Select",""],["","00378668977","PANTOPRAZOLE","40MG","31","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","-20","Select","Select",""],["","50228010710","METFORMIN","1000MG","62","Select","Select",""],["","56151034101","TRUPLUS ","MIS 28G","100","Select","Select",""],["","00378086005","CLOZAPINE ","TAB 100MG","14","Select","Select",""],["","00088221905","LANTUS ","INJ 100\/ML","3","Select","Select",""],["","68382007901","HALOPERIDOL ","TAB 5MG","62","Select","Select",""],["","53885024450","ONETOUCH ","TES ULTRA","50","Select","Select",""],["","69315013710","BENZTROPINE ","TAB 1MG","31","Select","Select",""],["","79854004112","VITAMIN ","TAB 2000UNIT","31","Select","Select",""],["","00378668977","PANTOPRAZOLE ","TAB 40MG","31","Select","Select",""],["","45802086803","POLYETH ","POW 3350 NF","510","Select","Select",""],["","08222095435","ULTIGUARD ","MIS 32GX4MM","100","Select","Select",""],["","00003089421","ELIQUIS ","TAB 5MG","62","Select","Select",""],["","62107005110","TACTINAL ","TAB 500MG","60","Select","Select",""],["","00006027754","JANUVIA ","TAB 100MG","31","Select","Select",""],["","47335090588","QUETIAPINE ","TAB 200MG","31","Select","Select",""],["","50228010710","METFORMIN ","TAB 1000MG","62","Select","Select",""],["","68462015713","ONDANSETRON ","TAB 4MG ODT","20","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","",""],["Yes","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":""}]}]}