{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NELL   R POWELL","gend":1,"add":"11300 MALL CT","city":"RICHMOND","state":"VA","zip":"23236-9998","dob":"1945-09-18","age":"","mstatus":"","insh":"900037145*01","cliId":"","pno":"804\/241-9264","cno":"","email":"","ename":"","eno":"","pphy":"MCMURRAY, KALI NP","ppno":"757\/222-0300","pcpadd":"2901 SOUTH LYNNHAVEN ROAD SUITE 450","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23452,"pcpcounty":"","pcpid":"","pcpname":"LEGACY CARE LLC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/965-9806","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R54.","R56.9","F79.","Z79.899","Z12.11","S90.821A","M79.671","I73.9","B35.1","M79.674","M79.675","N39.46","L22.","R39.81","F05.","G40.89","Z51.81","S61.419A","S09.90XA","Z74.3","E11.9","I70.203","E55.9","S01.01XA","G40.909","S09.8XXA","S01.81XA","S01.91XA","I10.","R63.4"],"date":["2021-08-10","2021-02-09","2021-08-10","2021-08-04","2020-07-23","2020-12-30","2020-12-30","2021-03-31","2021-09-23","2021-09-23","2021-09-23","2020-10-21","2020-10-21","2020-10-21","2020-09-08","2021-08-10","2020-03-04","2020-07-20","2020-09-08","2020-09-08","2021-08-18","2021-09-23","2021-04-28","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-09","2021-04-28","2021-05-12"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","16729018317","HYDROCHLOROTHIAZIDE                                                   ","25MG","29","Select","Select",""],["","65162083366","DICLOFENAC SODIUM                                                     ","1%","100","Select","Select",""],["","00071036924","DILANTIN                                                              ","100MG","62","Select","Select",""],["","57896010210","ACETAMINOPHEN                                                         ","325MG","124","Select","Select",""],["","00904615760","VITAMIN D                                                             ","2000UNIT","31","Select","Select",""],["","00904053980","THERA                                                                 ","","31","Select","Select",""],["","00071000740","DILANTIN INFATABS                                                     ","50MG","29","Select","Select",""],["","37000014343","ALIGN                                                                 ","4MG","31","Select","Select",""],["","24208091055","ERYTHROMYCIN                                                          ","OP","4","Select","Select",""],["","49884016111","CALCITONIN SALMON                                                     ","200\/ACT","4","Select","Select",""],["","00904323352","CALCIUM\/VITAMIN D                                                     ","600-400","62","Select","Select",""],["","00378210005","LOPERAMIDE HCL                                                        ","2MG","30","Select","Select",""],["","00781572005","POTASSIUM CHLORIDE ER                                                 ","20MEQ ER","60","Select","Select",""],["","00378156010","PHENYTOIN SODIUM EXTENDED                                             ","100MG","60","Select","Select",""],["","33332042010","AFLURIA QUADRIVALENT 2020-2021                                        ","2020-21","0","Select","Select",""],["","64980032212","RISAMINE                                                              ","","113","Select","Select",""],["","37000002404","METAMUCIL MULTIHEALTH FIBER SINGLES                                   ","58.12%","30","Select","Select",""],["","70461032103","FLUCELVAX QUADRIVALENT 2021-2022                                      ","2021-22","0","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}