{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN   G BENNETT","gend":0,"add":"6418 MACEDONIA ROAD","city":"WOODFORD","state":"VA","zip":"22580-9998","dob":"1955-05-15","age":"","mstatus":"","insh":"900042320*01","cliId":"","pno":"804\/461-9042","cno":"","email":"","ename":"","eno":"","pphy":"KING, PHILICIA NP","ppno":"540\/644-9505","pcpadd":"16463 DAHLGREN RD","pcpcity":"KING GEORGE","pcpstate":"VA","pcpzip":22485,"pcpcounty":"","pcpid":"","pcpname":"MARY WASHINGTON HEALTHCARE PHYSICIANS","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/644-9508","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J96.01","Z20.822","N39.0","J44.1","N40.0","Z79.51","G89.29","F17.200","R56.9","R06.9","R09.02","R06.89","R00.0","R91.1","J44.9","R91.8","Z00.00","A41.9","J98.11","R06.02","R22.41","I45.10","I44.4","I45.2","I51.7"],"date":["2021-08-18","2021-08-16","2021-08-17","2021-08-18","2021-08-17","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-17","2021-08-16","2021-08-16","2021-08-18","2021-09-16","2021-08-26","2021-01-28","2021-08-16","2021-08-16","2021-08-16","2021-09-23","2021-08-16","2021-08-16","2021-08-16","2021-08-16"],"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":[["","66993001968","ALBUTEROL SULFATE HFA                                                 ","HFA","54","Select","Select",""],["","57237001401","TAMSULOSIN HYDROCHLORIDE                                              ","0.4MG","90","Select","Select",""],["","00173071920","FLOVENT HFA                                                           ","110MCG","-12","Select","Select",""],["","00173088710","TRELEGY ELLIPTA                                                       ","ELLIPTA","60","Select","Select",""],["","69097015907","MELOXICAM                                                             ","15MG","30","Select","Select",""],["","00310461612","BREZTRI AEROSPHERE                                                    ","SPHERE","11","Select","Select",""],["","00487990130","ALBUTEROL SULFATE                                                     ","0.50%","30","Select","Select",""],["","60505384801","CELECOXIB                                                             ","100MG","120","Select","Select",""],["","68180016106","AZITHROMYCIN                                                          ","500MG","4","Select","Select",""],["","65862085901","FAMOTIDINE                                                            ","20MG","30","Select","Select",""],["","00093406130","FORMOTEROL FUMARATE                                                   ","20\/2ML","30","Select","Select",""],["","49502060530","PERFOROMIST                                                           ","20MCG","-60","Select","Select",""],["","68180012202","CEPHALEXIN                                                            ","500MG","8","Select","Select",""],["","73796045801","COMP AIR COMPRESSOR NEBULIZER                                         ","COMP\/NEB","1","Select","Select",""],["","59746000103","METHYLPREDNISOLONE DOSE PACK                                          ","4MG","-21","Select","Select",""],["","00115168974","BUDESONIDE                                                            ","0.5MG\/2","60","Select","Select",""],["","08373381800","PHILLIPS WILLIS THE WHALENEBULIZER                                    ","WHALE","1","Select","Select",""],["","00378064205","PREDNISONE                                                            ","20MG","18","Select","Select",""],["","24658031205","DOXYCYCLINE HYCLATE                                                   ","100MG","12","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":""}]}]}