{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" HARASRETNUH","gend":1,"add":"DISELGNE 622A2 TPA RIC E","city":"RICHMOND","state":"VA","zip":"23222-9998","dob":"1989-08-12","age":"","mstatus":"","insh":"7274110*68","cliId":"","pno":"88\/4081435-8","cno":"804\/200-8419","email":"","ename":"","eno":"","pphy":"MUELLER, GRACE K MD","ppno":"804\/828-2467","pcpadd":"1000 E BROAD STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23219,"pcpcounty":"","pcpid":"","pcpname":"MCV ASSOCIATED PHYSICIANS","plan":"OHP","program":"MEDICAID","lob":"M4","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":["O02.1","N76.0","Z11.3","Z30.9","Z3A.08","I10.","K43.9","O30.002","O10.912","O34.211","Z3A.24","Z33.1","Z34.90","O32.1XX1","O32.2XX2","Z37.2","Z3A.34","O20.0","O10.011","O30.001","Z3A.11","O34.212","O10.913","O32.1XX2","A59.9","F33.1","O30.003","O99.613","K42.9","O99.013","D64.9","Z3A.32","O10.92","V91.03","Z30.2","Z82.49","N93.9","Z3A.28","Z34.83","Z3A.20","O60.14X2","O60.14X1","O32.8XX1","O32.8XX2","O10.02","O99.892","N73.6"],"date":["2020-05-02","2020-04-30","2020-04-30","2020-04-30","2020-05-02","2020-05-02","2021-10-14","2021-08-23","2021-08-23","2021-11-07","2021-08-23","2021-10-14","2021-08-23","2021-11-08","2021-11-07","2021-11-07","2021-11-07","2021-05-24","2021-05-24","2021-05-24","2021-05-24","2021-11-08","2021-11-08","2021-11-08","2020-05-02","2020-10-05","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2020-12-28","2021-09-20","2021-09-20","2021-07-26","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07","2021-11-07"],"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":[["","","HYDROCHLOROT","CAP 12.5MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","MEDROXYPR","INJ 150MG\/ML","","Select","Select",""],["","","MISOPROSTOL","TAB 200MCG","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","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":[]}},{"a":{"indx":["","1"],"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":""}]}]}