{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JIMMIE   J CRIPPEN","gend":0,"add":"1313 CAREYBROOK DR","city":"HENRICO","state":"VA","zip":"23238-9998","dob":"1936-01-27","age":"","mstatus":"","insh":"900047631*01","cliId":"8CT1KV6AQ25","pno":"804\/307-5563","cno":"804\/307-5563","email":"","ename":"","eno":"","pphy":"FOUNTAIN-ELLIS, TAMI MD","ppno":"804\/741-6200","pcpadd":"9600 PATTERSON AVENUE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23229,"pcpcounty":"","pcpid":168334,"pcpname":"PATTERSON AVENUE FAMILY PRACTICE","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"Non-DSNP","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":["R29.6","Z47.32","U07.1","I10.","E87.1","E87.6","N17.9","S72.8X2D","F03.90","S72.002D","M62.81","Z96.642","R13.10","R26.2","R41.841","S72.002A","Z20.822","M25.78","Z91.19","Z78.9","R91.8","I49.3","R53.1","Y92.9"],"date":["2021-10-22","2021-10-22","2021-10-22","2021-10-22","2021-09-13","2021-09-13","2021-09-21","2021-09-16","2021-10-01","2021-11-03","2021-10-25","2021-10-01","2021-10-01","2021-10-25","2021-10-01","2021-09-02","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-09-13","2021-08-31","2021-09-20","2021-08-31"],"priorHcc":[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null]}},{"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":[["","68382097001","CHLORTHALID","TAB 25MG","90","Select","Select",""],["","54327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","68382097001","CHLORTHALIDONE","","90","Select","Select",""],["","54327099","FLUTICASONE PROPIONATE","","48","Select","Select",""],["","68180098003","LISINOPRIL","","90","Select","Select",""],["","68180098003","LISINOPRIL                                                            ","TAB 10MG","90","Select","Select",""],["","68382097001","CHLORTHALIDONE                                                        ","TAB 25MG","90","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE                                                ","SPR 50MCG","48","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","",""],["No","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":""}]}]}