{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AVERY   L SAGGESE","gend":1,"add":"10601 ACADEMY DR","city":"MIDLOTHIAN","state":"VA","zip":"23112-9998","dob":"1998-02-23","age":"","mstatus":"","insh":"900040247*01","cliId":"","pno":"804\/365-2722","cno":"","email":"","ename":"","eno":"","pphy":"MARSHALL, CHRISTOPHER MD","ppno":"804\/739-0910","pcpadd":"13861 HULL STREET ROAD","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":23112,"pcpcounty":"","pcpid":"","pcpname":"PRIMARY HEALTH GROUP INC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/739-2763","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z34.03","Z3A.37","R30.0","M62.830","Z01.419","Z12.4","R25.2","Z34.90","Z30.431","M54.6","Z30.430","Z32.02","Z39.2","M54.5","F31.5","O16.4","O71.4","O75.9","O99.344","Z37.0","Z88.0","Z3A.38","F25.0","O26.893","R10.2","Z3A.39","O80.","N39.0"],"date":["2020-10-06","2020-10-06","2020-10-30","2020-10-30","2020-12-01","2020-12-01","2021-05-10","2020-10-06","2021-01-05","2021-02-08","2020-12-01","2020-12-01","2020-12-01","2021-02-08","2021-02-02","2020-10-12","2020-10-12","2020-10-12","2020-10-12","2020-10-14","2020-10-12","2020-10-14","2020-09-10","2020-10-12","2020-10-12","2020-10-12","2020-10-14","2020-09-02"],"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":[["","00591410401","PERPHENAZINE                                                          ","16MG","30","Select","Select",""],["","43547028211","ESCITALOPRAM OXALATE                                                  ","20MG","30","Select","Select",""],["","43598065530","BUPROPION HYDROCHLORIDE ER (XL)                                       ","150MG XL","-30","Select","Select",""],["","55111018015","TIZANIDINE HYDROCHLORIDE                                              ","4MG","30","Select","Select",""],["","68180015301","DESLORATADINE                                                         ","5MG","90","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE                                                ","50MCG","16","Select","Select",""],["","67877021905","CEPHALEXIN                                                            ","500MG","20","Select","Select",""],["","59746000103","METHYLPREDNISOLONE DOSE PACK                                          ","4MG","21","Select","Select",""],["","69315013701","BENZTROPINE MESYLATE                                                  ","1MG","30","Select","Select",""],["","66993068530","OLANZAPINE                                                            ","20MG","30","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":""}]}]}