{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ATSIRHCPMURC ","gend":1,"add":"SUA 4234EVA NIT","city":"RICHMOND","state":"VA","zip":"23222-9998","dob":"1969-12-06","age":"","mstatus":"","insh":"80500210*14","cliId":"","pno":"69\/4087902-6","cno":"","email":"","ename":"","eno":"","pphy":"THOMAS, DENNIS L MD","ppno":"804\/932-4388","pcpadd":"1850 POCAHONTAS TRAIL","pcpcity":"QUINTON","pcpstate":"VA","pcpzip":23141,"pcpcounty":"","pcpid":"","pcpname":"CHICKAHOMINY FAMILY PRACTICE INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["F43.21","F34.1","H91.90","H61.23","Z01.411","Z00.00","I10.","M79.671","S92.424A","S92.414A","S90.31XA","M51.37","M54.32","M17.0","E66.01","G50.0","F33.1","F33.42","M79.2","R60.9","Z63.4","M19.90","M70.61","M25.552","M47.816","Z68.42","M46.1","R30.0","M70.62"],"date":["2021-11-29","2021-11-29","2020-06-23","2020-06-23","2020-11-23","2020-11-23","2021-08-10","2020-03-30","2020-03-30","2020-03-30","2020-03-30","2020-06-29","2020-06-29","2020-02-03","2020-02-03","2020-06-29","2020-06-29","2021-08-10","2021-08-10","2021-08-10","2019-01-07","2019-10-07","2019-06-20","2019-06-20","2019-06-20","2019-06-20","2019-03-11","2019-06-12","2019-06-12"],"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":[["","69315011610","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","65862020199","LOSARTAN","TAB 25MG","60","Select","Select",""],["","00591039860","DICLO\/MISOPR","TAB 75-0.2MG","60","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","69097012705","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","47335038383","DULOXETINE","CAP 60MG","30","Select","Select",""],["","50111044101","TRAZODONE","TAB 150MG","60","Select","Select",""],["","51672412401","CARBAMAZEPIN","TAB 200MG ER","120","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","00713055273","TERCONAZOLE","SUP 80MG","7","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","45","Select","Select",""],["","61442010301","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","","FLUCLVX","INJ 2020-21","","Select","Select",""],["","","CELECOXIB","CAP 100MG","","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","49281041910","FLUZONE","INJ 2019-20","0","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":""}]}]}