{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AKIA  C JONES","gend":1,"add":"5001 MEADOWLARK CT APT 110","city":"HENRICO","state":"VA","zip":"23231-9998","dob":"1982-01-02","age":"","mstatus":"","insh":"1813872*01","cliId":"","pno":"804\/878-1616","cno":"804\/878-1616","email":"","ename":"","eno":"","pphy":"MOORE, WILLIAM F MD","ppno":"804\/226-2444","pcpadd":"4620 S LABURNUM AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23231,"pcpcounty":"","pcpid":103130,"pcpname":"LABURNUM MEDICAL CENTER ","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"804\/665-5698","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/222-0458","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E66.01","E53.8","Z68.41","E55.9","I10.","T78.40XA","Z00.00","F41.9","G62.9","F43.23","R07.89","R06.00","Z87.891","Z68.24","F11.20","Z01.810","Z20.822","E87.6","K58.9","M25.50","D64.9","E46.","R53.83","E53.9","Z13.1"],"date":["2021-06-17","2021-01-26","2021-06-17","2021-05-21","2021-06-17","2021-06-17","2020-09-18","2021-06-17","2020-09-18","2020-12-09","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2020-01-07","2021-06-04","2021-06-17","2021-06-17","2021-06-17","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11","2020-08-11"],"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":[["","65862085901","FAMOTIDINE ","20MG","14","Select","Select",""],["","29300012910","HYDROCHLOROT ","50MG","90","Select","Select",""],["","51862088403","CAMILA ","0.35MG","28","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","15","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28","Select","Select",""],["","68462030529","NORETHINDRON ","0.35MG","84","Select","Select",""],["","00143122701","DICYCLOMINE ","20MG","20","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","30","Select","Select",""],["","10702001150","HYDROXYZ ","25MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","8","Select","Select",""],["","50428043400","ONE ","ESSENTL","90","Select","Select",""],["","10370010150","BUPROPN ","150MG XL","30","Select","Select",""],["","43199001101","HYOSCYAMINE ","0.125MG","30","Select","Select",""],["","00245531911","KLOR-CON ","20MEQ ER","30","Select","Select",""],["","59779050301","OMEPRAZOLE ","20MG","90","Select","Select",""],["","42858030101","HYDROMORPHON ","2MG","12","Select","Select",""],["","24658031205","DOXYCYCL ","100MG","14","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}