{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICHARD T JOHNSON","gend":0,"add":"1122 FAIRGROUNDS RD","city":"FARMVILLE","state":"VA","zip":23901,"dob":"1936-07-03","age":"","mstatus":"","insh":"900046797*01","cliId":"","pno":"434\/394-8025","cno":"","email":"","ename":"","eno":"","pphy":"BLACKWELL, BRIAN K MD","ppno":"434\/581-3271","pcpadd":"25892 N JAMES MADISON HWY","pcpcity":"NEW CANTON","pcpstate":"VA","pcpzip":23123,"pcpcounty":"BUCKINGHAM","pcpid":44129,"pcpname":"","plan":"OHP - OPTIMA","program":"MEDICARE","lob":"DSNP","region":"Greater Richmond","aligned":"N","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":[],"date":[],"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[["","904576960","ARTHRTS PAIN ","TAB 650MG","30","Select","Select",""],["","60505257808","ATORVASTATIN TAB ","10MG","30","Select","Select",""],["","68382013210","TAMSULOSIN CAP ","0.4MG","30","Select","Select",""],["","29300034905","ALLOPURINOL TAB ","100MG","60","Select","Select",""],["","68180096301","ALBUTEROL AER ","HFA","8","Select","Select",""],["","65862012701","TORSEMIDE TAB ","20MG","60","Select","Select",""],["","16729022517","SPIRONOLACT TAB ","25MG","30","Select","Select",""],["","13668042990","PANTOPRAZOLE TAB ","40MG","30","Select","Select",""],["","49483048112","ASPIRIN LOW ","TAB 81MG EC","30","Select","Select",""],["","24338001009","BIDIL  ","TAB","60","Select","Select",""],["","70954005920","PREDNISONE TAB ","10MG","18","Select","Select",""],["","67877012425","SILVER SULFA ","CRE 1%","25","Select","Select",""],["","43598021055","SSD  "," CRE 1%","-50","Select","Select",""],["","3089321","ELIQUIS  ","TAB 2.5MG","-60","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":[[["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Select","Select","","","","","Select","",""],["No","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":""}]}]}