{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARTER BRYANT","gend":0,"add":"3348 SOUTH MEADOW CIR","city":"POWHATAN","state":"VA","zip":"23139-9998","dob":"1962-07-08","age":"","mstatus":"","insh":"1405528*01","cliId":"","pno":"804\/647-6166","cno":"804\/647-6166","email":"","ename":"","eno":"","pphy":"GREENFIELD, SCOTT R MD","ppno":"804\/968-5700","pcpadd":"5000 COX RD STE 100","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":"23060-9998","pcpcounty":"","pcpid":125475,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"CENTRAL","aligned":"","ano":"804\/647-6166","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":["I08.0","I50.30","I87.2","M79.89","G47.33","I10.","S82.291A","I48.0","I45.10","I42.2","Z68.41"],"date":["2021-03-11","2021-03-11","2021-06-07","2021-06-07","2021-05-04","2021-04-28","2021-06-18","2021-03-11","2021-03-11","2021-03-11","2021-03-11"],"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":[["","68645019059","METOPROL","50MG","180","Select","Select",""],["","43547040211","FUROSEMIDE","40MG","90","Select","Select",""],["","00003089421","ELIQUIS","5MG","-180","Select","Select",""],["","47781065990","LEVOTHYROXIN","137MCG","-90","Select","Select",""],["","72305013730","EUTHYROX","137MCG","-90","Select","Select",""],["","80777027310","MODERNA","COVID-19","0","Select","Select",""],["","47781065990","LEVOTHYROXIN ","137MCG","90","Select","Select",""],["","80777027310","MODERNA ","COVID-19","0","Select","Select",""],["","68645019059","METOPROL ","50MG","180","Select","Select",""],["","00003089421","ELIQUIS ","5MG","-180","Select","Select",""],["","72305013730","EUTHYROX ","137MCG","90","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","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","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}