{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANICE   E ADKINS","gend":1,"add":"4909 ADKINS ROAD","city":"PROVIDENCE FORGE","state":"VA","zip":"23140-9998","dob":"1944-12-31","age":"","mstatus":"","insh":"20022908*01","cliId":"","pno":"804\/998-7610","cno":"804\/998-7610","email":"","ename":"","eno":"","pphy":"THOMAS, DENNIS L MD","ppno":"804\/932-4388","pcpadd":"1850 POCAHONTAS TRAIL","pcpcity":"QUINTON","pcpstate":"VA","pcpzip":23141,"pcpcounty":"","pcpid":671676,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/932-9860","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L30.4","B37.9"],"date":["2021-08-23","2021-08-23"],"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":[["","16729018317","HYDROCHLOROT ","25MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE ","40MG","30","Select","Select",""],["","68382002101","VENLAFAXINE ","75MG","60","Select","Select",""],["","00093720298","PRAVASTATIN ","40MG","30","Select","Select",""],["","00228291809","DILTIAZEM ","360MG ER","30","Select","Select",""],["","68180037803","LOSARTAN ","100MG","30","Select","Select",""],["","00168009960","KETOCONAZOLE ","2%","60","Select","Select",""],["","68462039710","OMEPRAZOLE","40MG","30","Select","Select",""],["","68382002101","VENLAFAXINE","75MG","60","Select","Select",""],["","65862020399","LOSARTAN","100MG","30","Select","Select",""],["","16729018317","HYDROCHLOROT","25MG","30","Select","Select",""],["","00093720298","PRAVASTATIN","40MG","30","Select","Select",""],["","68382059916","DILTIAZEM","360MG ER","30","Select","Select",""],["","00168009960","KETOCONAZOLE","2%","60","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","",""],["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":""}]}]}