{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENNETH   A JACOBS","gend":0,"add":"7336 CARY AVE","city":"GLOUCESTER","state":"VA","zip":"23061-9998","dob":"1956-01-08","age":"","mstatus":"","insh":"900049123*01","cliId":"9KA5QH3WY70","pno":"804\/693-7035","cno":"804\/693-7035","email":"","ename":"","eno":"","pphy":"DOEREN, BRIAN MD","ppno":"757\/941-5600","pcpadd":"263 MCLAWS CIRCLE SUITE 105","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23185,"pcpcounty":"","pcpid":159520,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/564-0557","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25.10","F17.210","Z23.","N18.30","Z79.899","F31.9","R09.89","I25.2"],"date":["2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-11-22","2021-11-22","2021-11-22"],"priorHcc":[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":[["","68001032203","BUPROPION HYDROCHLORIDE ER (XL)","150MG XL","31","Select","Select",""],["","43547035150","LISINOPRIL","2.5MG","31","Select","Select",""],["","33342007107","OLANZAPINE","15MG","31","Select","Select",""],["","68462026190","ROSUVASTATIN CALCIUM","5MG","31","Select","Select",""],["","68382008001","HALOPERIDOL","10MG","31","Select","Select",""],["","62756043088","LITHIUM CARBONATE","300MG","93","Select","Select",""],["","68001032203","BUPROPION HYDROCHLORIDE ER (XL)                                       ","TAB 150MG XL","31","Select","Select",""],["","43547035150","LISINOPRIL                                                            ","TAB 2.5MG","31","Select","Select",""],["","68462026190","ROSUVASTATIN CALCIUM                                                  ","TAB 5MG","31","Select","Select",""],["","33342007115","OLANZAPINE                                                            ","TAB 15MG","31","Select","Select",""],["","69618006610","ASPIRIN ADULT LOW STRENGTH                                            ","TAB 81MG EC","31","Select","Select",""],["","62756043088","LITHIUM CARBONATE                                                     ","TAB 300MG","93","Select","Select",""],["","00182101701","VITAMIN B-12                                                          ","TAB 1000MCG","31","Select","Select",""],["","68382008001","HALOPERIDOL                                                           ","TAB 10MG","31","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","",""],["Yes","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":""}]}]}