{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" V  YRAMSELBMUH","gend":1,"add":"HCIR 0526YWH DNOM","city":"GLADSTONE","state":"VA","zip":24553,"dob":"1949-09-15","age":"","mstatus":"","insh":"59200210*15","cliId":"","pno":"09\/4343521-7","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"434\/263-4752","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":24553,"pcpcounty":"","pcpid":"","pcpname":"BLUE RIDGE HEALTH CENTER INC","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","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":["Z20.828","M25.512","Z23.","E11.65","H35.3131","H26.493","NO DATA","H26.491","H26.492","Z96.1","H43.393"],"date":["2020-12-01","2020-12-01","2021-04-26","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-09-24","2021-10-15","2019-02-22","2019-02-22"],"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":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","50228010510","METFORMIN","TAB 500MG","120","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","69238183201","LEVOTHYROXIN","TAB 75MCG","30","Select","Select",""],["","65862020390","LOSARTAN","TAB 100MG","30","Select","Select",""],["","31722051210","SIMVASTATIN","TAB 20MG","30","Select","Select",""],["","43975030410","INDAPAMIDE","TAB 2.5MG","30","Select","Select",""],["","68462039701","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","50742026101","NIFEDIPINE","TAB 60MG ER","60","Select","Select",""],["","57664047758","METOPROL","TAB 50MG","60","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA BL","300","Select","Select",""],["","08222094193","INSULIN","MIS 1ML\/31G","100","Select","Select",""],["","00904423960","MAGNESIUM","TAB 500MG","60","Select","Select",""],["","42167000554","LANCET","MIS THIN 30G","300","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","70877858801","TALIVA","CAP ","30","Select","Select",""],["","69336040230","PRODIGEN","CAP ","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":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"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":""}]}]}