{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" JIMMY ALLAN GARLAND","gend":0,"add":"1832 HIGHWAY 58","city":"BUFFALO JUNCTION","state":"VA","zip":"24529-9998","dob":"1961-06-24","age":"","mstatus":"","insh":"2301123*01","cliId":"","pno":"606\/568-1439","cno":"606\/568-1439, 434\/362-2012, ","email":"","ename":"","eno":"","pphy":"HUNDLEY, SUSAN DUPUY MD","ppno":"434\/738-6420","pcpadd":"380 WASHINGTON STREET","pcpcity":"BOYDTON","pcpstate":"VA","pcpzip":"23917-9998","pcpcounty":"","pcpid":125561,"pcpname":"","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R50.9","Z03.89","I10.","E78.2","F32.9","R79.9","Z79.899","Z12.5","Z13.29"],"date":["2020-11-20","2020-11-20","2021-04-26","2021-04-26","2020-06-29","2020-06-29","2020-06-29","2020-10-19","2020-10-19"],"priorHcc":["","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","68382009601","HYDROXYCHLOR","200MG","180","Select","Select",""],["","50228014610","HYDROCHLOROT","12.5MG","90","Select","Select",""],["","50428029742","FISH","1000MG","60","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","90","Select","Select",""],["","50742061610","METOPROL","50MG ER","90","Select","Select",""],["","00378001401","METHOTREXATE","2.5MG","24","Select","Select",""],["","70377000712","ROSUVASTATIN","10MG","30","Select","Select",""],["","68180016006","AZITHROMYCIN","250MG","6","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}