{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELVIN   R RICE JR","gend":0,"add":"308 SEABURY AVE","city":"SANDSTON","state":"VA","zip":"23150-9998","dob":"1955-03-16","age":"","mstatus":"","insh":"900042272*01","cliId":"","pno":"804\/475-7687","cno":"","email":"","ename":"","eno":"","pphy":"KOWALSKI, JOHN P M D","ppno":"804\/795-1144","pcpadd":"2660 NEW MARKET RD","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23231,"pcpcounty":"","pcpid":"","pcpname":"CHICKAHOMINY FAMILY PRACTICE INC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/795-1052","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25.118","I25.2","I25.5","I10.","Z12.11","F17.210","I25.10","E78.5","J44.9","J84.9","R91.8","G47.09","R06.00","E66.3","Z23.","Z68.26","N52.8","Z12.5","E78.2"],"date":["2021-09-20","2021-09-20","2021-09-20","2021-12-09","2021-08-11","2021-12-09","2021-12-09","2021-12-09","2021-04-22","2021-04-22","2021-04-22","2021-12-09","2021-04-13","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-03-26"],"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":[]}]},{"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":[["","76385011250","CARVEDILOL                                                            ","12.5MG","-180","Select","Select",""],["","00186077760","BRILINTA                                                              ","90MG","180","Select","Select",""],["","70377003012","ATORVASTATIN CALCIUM                                                  ","80MG","90","Select","Select",""],["","68180051303","LISINOPRIL                                                            ","5MG","90","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","HFA","54","Select","Select",""],["","13107008501","LORAZEPAM                                                             ","2MG","30","Select","Select",""],["","13668000805","ZOLPIDEM TARTRATE                                                     ","10MG","30","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER                                                    ","HANDIHLR","90","Select","Select",""],["","00173086910","ANORO ELLIPTA                                                         ","62.5-25","60","Select","Select",""],["","70436001002","BUPROPION HYDROCHLORIDE ER (XL)                                       ","150MG XL","73","Select","Select",""],["","00093026492","FLUOCINONIDE                                                          ","0.05%","60","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}