{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOSEPH HENDERSON","gend":0,"add":"7161 SUNSET CT","city":"MECHANICSVILLE","state":"VA","zip":"23111-9998","dob":"1976-03-29","pno":"804\/651-3161","cno":"804\/651-3161","email":"","pphy":"FIERRO, ANTHONY MD","ppno":"","pcpadd":"7001 FOREST AVE SUITE 302","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23230,"pcpcounty":"","pcpid":137033,"pcpname":"PartnerMD","insh":"2354800*01","cliId":"","plan":"OHP","program":"ACA","lob":"Individual","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/282-0676","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","K70.10","E04.9","K21.9","R13.10","K21.00","Z12.5","D53.9","Z11.59","Z87.891","Z79.890","K71.9","L85.3","K70.30","K29.50","K31.9"],"date":["2021-09-07","2021-09-07","2021-09-07","2021-09-27","2021-09-21","2021-09-27","2021-08-12","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-09-02","2021-08-12","2021-09-27","2021-09-27","2021-09-27"],"priorHcc":["","","",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":[["","59310057922","PROAIR","","8","Select","Select",""],["","69238184001","LEVOTHYROXIN","200MCG","90","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","-30","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","68382050010","OMEPRAZOLE ","CAP 40MG","-30","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","7","Select","Select",""],["","69238184001","LEVOTHYROXIN ","TAB 200MCG","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","",""],["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":""}]}]}