{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA   C MCCOY","gend":1,"add":"6813 BRUSHY RIDGE ROAD","city":"NORA","state":"VA","zip":"24272-9998","dob":"1961-03-21","age":"","mstatus":"","insh":"900044080*01","cliId":"","pno":"276\/495-8092","cno":"","email":"","ename":"","eno":"","pphy":"NIDA, MAURICE E DO","ppno":"276\/679-0321","pcpadd":"295 WHARTON LN","pcpcity":"NORTON","pcpstate":"VA","pcpzip":24273,"pcpcounty":"","pcpid":"","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"SOUTHWEST","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/679-6498","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M17.0","G25.0","Z79.899","G62.9","M54.5","G47.33","Z00.00","Z99.89","I10.","Z12.31","R73.09","F32.9","E55.9","J30.1","H65.93","H60.501","M48.02","M51.36","Z12.11","M25.569","E78.2","Z23.","M54.50","F32.A","F41.9"],"date":["2021-10-18","2021-10-13","2021-07-12","2021-10-13","2021-07-12","2021-07-12","2021-10-13","2021-07-12","2021-10-27","2021-06-10","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-10-13","2021-10-13","2021-04-05","2021-04-05","2021-05-23","2021-08-13","2021-10-27","2021-10-13","2021-10-13","2021-10-13","2021-10-13"],"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":[["","71930002052","HYDROCODONE BITARTRATE\/ACETAMINOPHEN                                  ","7.5-325","60","Select","Select",""],["","68382014005","TOPIRAMATE                                                            ","100MG","60","Select","Select",""],["","23155050110","HYDROXYZINE HYDROCHLORIDE                                             ","25MG","30","Select","Select",""],["","65162011550","HYDROCODONE\/ACETAMINOPHEN                                             ","7.5-325","60","Select","Select",""],["","00591555705","PROPRANOLOL HYDROCHLORIDE                                             ","80MG","180","Select","Select",""],["","00093719805","FLUOXETINE HYDROCHLORIDE                                              ","40MG","180","Select","Select",""],["","65862052305","GABAPENTIN                                                            ","600MG","270","Select","Select",""],["","16729018317","HYDROCHLOROTHIAZIDE                                                   ","25MG","30","Select","Select",""],["","60505257908","ATORVASTATIN CALCIUM                                                  ","20MG","30","Select","Select",""],["","31722070210","LOSARTAN POTASSIUM                                                    ","100MG","90","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE                                                ","50MCG","16","Select","Select",""],["","75834002001","VITAMIN D3                                                            ","50000UNT","4","Select","Select",""],["","43598081115","CETIRIZINE HYDROCHLORIDE                                              ","10MG","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":""}]}]}