{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LATANYA   D WASHINGTON","gend":1,"add":"633 44TH ST","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1969-05-11","pno":"757\/819-2088","cno":"","email":"","pphy":"DELAHOUSSAYE, ALADEE R MD","ppno":"","pcpadd":"4714 MARSHALL AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":142743,"pcpname":"","insh":"900048943*01","cliId":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R94.5","I82.91","I48.19","E78.5","Z09.","I48.91","I48.3","I50.22","Z95.810","I42.8","I51.3","I27.82","N28.0","Z91.19","N19."],"date":["2021-11-03","2021-11-24","2021-11-18","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-08"],"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":[["","16729003410","LETROZOLE                                                             ","TAB 2.5MG","90","Select","Select",""],["","65862073260","AMIODARONE HYDROCHLORIDE                                              ","TAB 200MG","30","Select","Select",""],["","69238199101","DIGOXIN                                                               ","TAB 0.125MG","30","Select","Select",""],["","00054429931","FUROSEMIDE                                                            ","TAB 40MG","60","Select","Select",""],["","69452015120","VITAMIN D                                                             ","CAP 50000UNT","12","Select","Select",""],["","55111012305","ATORVASTATIN CALCIUM                                                  ","TAB 40MG","30","Select","Select",""],["","65862020199","LOSARTAN POTASSIUM                                                    ","TAB 25MG","30","Select","Select",""],["","68462016305","CARVEDILOL                                                            ","TAB 6.25MG","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":""}]}]}