{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THURSTON   L WHITE","gend":0,"add":"307 PITT ST","city":"FREDERICKSBURG","state":"VA","zip":"22401-9998","dob":"1960-07-02","age":"","mstatus":"","insh":"20017016*01","cliId":"","pno":"571\/286-9843","cno":"571\/286-9843","email":"","ename":"","eno":"","pphy":"OSBORNE-WU, JEWEL MD","ppno":"703\/535-5568","pcpadd":"2 EAST GLEBE ROAD","pcpcity":"ALEXANDRIA","pcpstate":"VA","pcpzip":22305,"pcpcounty":"","pcpid":131083,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["Z20.828","L23.7","I10.","F17.210","Z23.","S61.411A","W26.8XXA","Y92.89","Y93.89","E11.9","Z86.73","H02.843","E66.09","Z68.31","Z72.0","E11.40","R82.71","V58.89"],"date":["2020-11-30","2021-06-21","2021-08-04","2021-08-04","2021-04-17","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-06-21","2021-06-21","2021-06-21","2021-01-29","2021-01-29","2021-01-29","2021-01-30","2021-01-30","2021-08-04"],"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":[["","68382075905","METFORMIN ","850MG","60","Select","Select",""],["","00228212910","CLONIDINE ","0.3MG","60","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","21","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","30","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","21","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","30","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","20","Select","Select",""],["","00378064205","PREDNISONE ","20MG","15","Select","Select",""],["","00228212910","CLONIDINE","0.3MG","60","Select","Select",""],["","68382075905","METFORMIN","850MG","60","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","21","Select","Select",""],["","67877032105","IBUPROFEN","800MG","21","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","00378064205","PREDNISONE","20MG","15","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}