{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BURRINGTON   G MOORE","gend":0,"add":"15108 BOYDTON PLANK ROAD","city":"DINWIDDIE","state":"VA","zip":"23841-9998","dob":"1951-02-19","age":"","mstatus":"","insh":"900039904*01","cliId":"","pno":"804\/469-6057","cno":"","email":"","ename":"","eno":"","pphy":"PARK, HYO K DO","ppno":"804\/469-3731","pcpadd":"13855 COURTHOUSE ROAD","pcpcity":"DINWIDDIE","pcpstate":"VA","pcpzip":23841,"pcpcounty":"","pcpid":"","pcpname":"SOUTHERN DOMINION HEALTH SYSTEM INC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/469-5307","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23.","E11.65","I10.","R35.0","Z79.4","E66.3","Z68.25","R63.4","K40.20","E78.00","I69.398","Z68.27","R74.8","D69.6","K22.2","R73.9","E78.5","F10.21","Z68.28"],"date":["2021-10-13","2021-12-14","2021-12-14","2021-11-02","2021-11-02","2021-11-08","2021-11-02","2021-11-30","2021-11-30","2021-12-14","2021-11-08","2021-11-08","2021-11-08","2021-02-01","2021-09-23","2021-11-02","2021-09-23","2021-09-23","2021-08-02"],"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":[["","29300012810","HYDROCHLOROTHIAZIDE                                                   ","25MG","90","Select","Select",""],["","55111012105","ATORVASTATIN CALCIUM                                                  ","10MG","90","Select","Select",""],["","65862056090","PANTOPRAZOLE SODIUM                                                   ","40MG","90","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE                                                   ","10MG","90","Select","Select",""],["","68180098103","LISINOPRIL                                                            ","20MG","90","Select","Select",""],["","59746036290","VALSARTAN                                                             ","160MG","-90","Select","Select",""],["","00363237102","LANCETS MICRO THIN 33G                                                ","THIN 33G","200","Select","Select",""],["","56151146001","TRUE METRIX BLOOD GLUCOSETEST STRIPS                                  ","GLUCOSE","200","Select","Select",""],["","00378718505","METFORMIN HYDROCHLORIDE                                               ","500MG","180","Select","Select",""],["","56151147002","TRUE METRIX BLOOD GLUCOSEMETER                                        ","METER","1","Select","Select",""],["","08290320882","BD PEN NEEDLE\/MINI\/ULTRA-FINE\/31G X 5MM                               ","31GX5MM","90","Select","Select",""],["","00088221905","LANTUS SOLOSTAR                                                       ","100\/ML","15","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":""}]}]}