{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONYA   M GARLINGTON","gend":1,"add":"919 W LITTLE CREEK RD APT 4","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1968-01-21","age":"","mstatus":"","insh":"900048883*01","cliId":"1N49CN0CH48","pno":"757\/668-8890","cno":"757\/668-8890","email":"","ename":"","eno":"","pphy":"SADR, SHARON MD","ppno":"757\/889-6733","pcpadd":"STE 411 110 KINGSLEY LANE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":116174,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":"Non-DSNP","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/889-6731","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I67.9","D32.9","R22.0","Z12.31","I67.82","M10.9","M25.572","M19.079","M65.9","M05.79","Z51.81","M54.50","G89.29","L70.0","R21."],"date":["2021-08-06","2021-11-03","2021-08-23","2021-10-21","2021-10-23","2021-10-29","2021-09-28","2021-09-28","2021-09-28","2021-10-29","2021-10-29","2021-10-29","2021-10-29","2021-07-29","2021-07-29"],"priorHcc":[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":[["","68382009605","HYDROXYCHLOROQUINE SULFATE","200MG","30","Select","Select",""],["","65162046650","IBUPROFEN","800MG","270","Select","Select",""],["","00074230630","RINVOQ","15MG ER","30","Select","Select",""],["","00406012305","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","TAB 5-325MG","28","Select","Select",""],["","65162046650","IBUPROFEN                                                             ","TAB 800MG","270","Select","Select",""],["","00074230630","RINVOQ                                                                ","TAB 15MG ER","30","Select","Select",""],["","45802096696","ERYTHROMYCIN                                                          ","GEL 0.02","60","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HYDROCHLORIDE                                         ","TAB 10MG","30","Select","Select",""],["","68382009605","HYDROXYCHLOROQUINE SULFATE                                            ","TAB 200MG","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":""}]}]}