{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SALLIE   M HATCHER","gend":1,"add":"9006 PEPPERIDGE RD APT 202","city":"RICHMOND","state":"VA","zip":"23236-9998","dob":"1959-09-19","age":"","mstatus":"","insh":"20028866*01","cliId":"","pno":"804\/308-0565","cno":"804\/308-0565","email":"","ename":"","eno":"","pphy":"BREEDEN, SARA MD","ppno":"804\/271-8990","pcpadd":"6439 IRONBRIDGE RD","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23234,"pcpcounty":"","pcpid":147624,"pcpname":"Primary Health Group - Ironbridge","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/271-9020","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","G89.29","M79.89","Z72.0","M79.673","E78.5","I63.9","M54.9","E83.52","R21.","Z12.39","M25.50","E78.2","Z12.11","M54.5","R73.03","Z01.30"],"date":["2021-08-02","2020-09-25","2020-09-04","2020-09-04","2020-09-04","2021-06-28","2020-08-14","2021-08-02","2020-12-04","2021-06-28","2020-12-04","2021-03-26","2021-03-26","2021-06-28","2021-06-28","2020-09-25","2021-08-02"],"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":[["","45802006535","TRIAMCINOLON ","0.50%","15","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","69238115403","EZETIMIBE ","10MG","30","Select","Select",""],["","00781107801","ATENOLOL ","25MG","30","Select","Select",""],["","68645051054","HYDROCHLOROT ","25MG","30","Select","Select",""],["","68645051554","AMLODIPINE ","5MG","30","Select","Select",""],["","00904678370","ASPIRIN ","81MG EC","100","Select","Select",""],["","69097052444","DICLOFENAC ","1%","100","Select","Select",""],["","59676058005","JANSSEN ","COVID-19","0","Select","Select",""],["","45802006535","TRIAMCINOLON","0.50%","15","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","69238115403","EZETIMIBE","10MG","30","Select","Select",""],["","00093078701","ATENOLOL","25MG","30","Select","Select",""],["","68645051054","HYDROCHLOROT","25MG","30","Select","Select",""],["","68645051554","AMLODIPINE","5MG","30","Select","Select",""],["","00904678370","ASPIRIN","81MG EC","90","Select","Select",""],["","69097052444","DICLOFENAC","1%","100","Select","Select",""],["","59676058005","JANSSEN","COVID-19","0","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":""}]}]}