{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VERNARD   L HAMM JR","gend":0,"add":"6700 POPLAR SPRINGS ROAD","city":"HENRICO","state":"VA","zip":"23231-9998","dob":"1965-02-18","age":"","mstatus":"","insh":"20028516*01","cliId":"","pno":"804\/852-8214","cno":"804\/852-8214","email":"","ename":"","eno":"","pphy":"GOKLI, ANUP J 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":"804\/319-0088","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/932-9860","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","G89.4","M15.9","I89.0","M25.511","E78.2","R73.09","R53.83","M25.562","Z79.899","M54.5","M54.9","Z23.","M54.2","F41.1","I87.2"],"date":["2021-03-01","2021-03-01","2021-03-01","2021-06-07","2020-05-01","2021-09-13","2020-08-07","2021-06-07","2021-06-07","2021-09-13","2020-11-27","2020-11-30","2020-11-30","2021-09-13","2021-09-13","2021-09-13"],"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":[["","69315011710","FUROSEMIDE ","40MG","30","Select","Select",""],["","43547043109","FENOFIBRATE ","145MG","30","Select","Select",""],["","55111064534","OMEPRAZOLE ","40MG","30","Select","Select",""],["","65162062750","TRAMADOL ","50MG","60","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","55111018015","TIZANIDINE ","4MG","20","Select","Select",""],["","43547043109","FENOFIBRATE","145MG","30","Select","Select",""],["","65162062750","TRAMADOL","50MG","60","Select","Select",""],["","69315011710","FUROSEMIDE","40MG","30","Select","Select",""],["","55111064534","OMEPRAZOLE","40MG","30","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","55111018015","TIZANIDINE","4MG","20","Select","Select",""],["","65862042001","SMZ\/TMP","800-160","20","Select","Select",""],["","65862042001","SMZ\/TMP ","TAB 800-160","20","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","",""],["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":""}]}]}