{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CINDY   A FENSKE","gend":1,"add":"18315 WRIGHTSVILLE ROAD","city":"BOWLING GREEN","state":"VA","zip":"22427-9998","dob":"1946-12-10","pno":"412\/667-9842","cno":"412\/667-9842","email":"","pphy":"HUOT, RACHEL MD","ppno":"","pcpadd":"102 W BROADDUS AVE SUITE 200","pcpcity":"BOWLING GREEN","pcpstate":"VA","pcpzip":22427,"pcpcounty":"","pcpid":209163,"pcpname":"","insh":"900048734*01","cliId":"5NJ9WV4UK44","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/632-1033","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.116","I10.","E11.9","E78.2","M79.672","M79.89","S99.929A"],"date":["2021-08-12","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03","2021-08-03"],"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":[["","16571020150","DICLOFENAC","75MG DR","45","Select","Select",""],["","61314054701","LATANOPROST","0.01%","2","Select","Select",""],["","50111091701","TORSEMIDE","20MG","90","Select","Select",""],["","00378003210","METOPROL","50MG","180","Select","Select",""],["","67877056105","METFORMIN","500MG","180","Select","Select",""],["","65862037501","ESCITALOPRAM","20MG","-90","Select","Select",""],["","43547035611","LISINOPRIL","40MG","90","Select","Select",""],["","62332025050","DOXYCYC","100MG","20","Select","Select",""],["","00378395305","ATORVASTATIN","80MG","90","Select","Select",""],["","00378003210","METOPROL ","TAB 50MG","180","Select","Select",""],["","67877056105","METFORMIN ","TAB 500MG","180","Select","Select",""],["","50111091701","TORSEMIDE ","TAB 20MG","90","Select","Select",""],["","43547035611","LISINOPRIL ","TAB 40MG","90","Select","Select",""],["","65862037501","ESCITALOPRAM ","TAB 20MG","90","Select","Select",""],["","62332025050","DOXYCYC ","CAP 100MG","20","Select","Select",""],["","00378395305","ATORVASTATIN ","TAB 80MG","90","Select","Select",""],["","16571020150","DICLOFENAC ","TAB 75MG DR","45","Select","Select",""],["","61314054701","LATANOPROST ","SOL 0.00005","2","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":""}]}]}