{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNA   O HUGHS","gend":1,"add":"3311 GLOUCESTER ROAD","city":"RICHMOND","state":"VA","zip":"23227-9998","dob":"1951-10-04","age":"","mstatus":"","insh":"900044279*01","cliId":"6NN0H23TR22","pno":"804\/304-7651","cno":"804\/304-7651","email":"","ename":"","eno":"","pphy":"DU, BETH S MD","ppno":"804\/288-3079","pcpadd":"7001 FOREST AVE SUITE 405","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23230,"pcpcounty":"","pcpid":164750,"pcpname":"WEST END INTERNAL MEDICINE","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/282-6159","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.1","J30.89","R92.8","Z12.31","E78.5","L82.0","H57.89","H10.45","N64.89","R92.2","F41.1","G47.09","Z63.4","Z01.82"],"date":["2021-07-29","2021-07-29","2021-02-08","2021-01-28","2021-05-27","2021-04-29","2021-02-18","2021-02-18","2021-02-08","2021-02-08","2021-08-09","2021-08-09","2021-08-09","2021-07-29"],"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":[["","51991081403","AZELASTINE ","0.10%","90","Select","Select",""],["","13668008105","MONTELUKAST ","10MG","90","Select","Select",""],["","29300013201","ZALEPLON ","10MG","90","Select","Select",""],["","59746032430","VALACYCLOVIR ","500MG","90","Select","Select",""],["","0","","","30","Select","Select",""],["","47781010444","ESTRADIOL ","0.01%","42","Select","Select",""],["","00555087302","MEDROXYPR ","5MG","90","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","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","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":""}]}]}