{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOSEPH   M HAVENS","gend":0,"add":"22950 JOHNSON ROAD","city":"JETERSVILLE","state":"VA","zip":"23083-9998","dob":"1989-12-22","age":"","mstatus":"","insh":"1614277*01","cliId":"","pno":"804\/405-6529","cno":"804\/405-6529","email":"","ename":"","eno":"","pphy":"HATCH, KAREN MD","ppno":"804\/270-2150","pcpadd":"5000 COX RD STE 100","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":125476,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"CENTRAL","aligned":"","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":["T14.90XA","V89.2XXA","S02.2XXA","M25.522","S06.0X9S","R40.4","S06.0X0A","G44.309","R41.89","R53.83","H53.149","R41.3","V49.40XS","G47.9","F32.9","J02.9","G47.00","S06.9X9S","F41.9","F41.0","Z71.82","S09.8XXA","S02.40CA","S02.40DA","S29.9XXA"],"date":["2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-08-10","2020-06-08","2020-08-10","2020-08-17","2020-07-20","2020-07-20","2020-07-20","2020-08-17","2020-07-20","2020-07-20","2020-08-17","2020-11-29","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-06-08","2020-06-08","2020-06-08","2020-06-08"],"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":[["","50111064801","FLUOXETINE","20MG","90","Select","Select",""],["","51862001601","NORTRIPTYLIN","25MG","-90","Select","Select",""],["","62756052169","SUMATRIPTAN","50MG","-18","Select","Select",""],["","70710122600","AMITRIPTYLIN","25MG","-90","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","50383077504","LIDOCAINE","2% VISC","100","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","30","Select","Select",""],["","51862001601","NORTRIPTYLIN ","25MG","90","Select","Select",""],["","50111064801","FLUOXETINE ","20MG","90","Select","Select",""],["","70710122600","AMITRIPTYLIN ","25MG","90","Select","Select",""],["","62756052169","SUMATRIPTAN ","50MG","-18","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","100","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","30","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","",""],["No","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":""}]}]}