{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MACUM   D WHITE","gend":1,"add":"3039 N RIVERSIDE DR","city":"QUINTON","state":"VA","zip":23141,"dob":"1952-01-05","age":"","mstatus":"","insh":"20037256*01","cliId":"","pno":"757\/566-1247","cno":"757\/566-1247","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":["I12.9","N18.2","E78.2","K21.9","E11.21","E11.40","N18.3","N18.4","E11.9","E55.9","NO DATA","M79.2","E66.01","M25.50","E11.22","Z79.84","I10.","Z79.899","E11.59","F33.1"],"date":["2021-08-19","2021-05-11","2021-08-19","2021-05-11","2020-07-31","2020-04-23","2020-07-31","2020-10-01","2021-09-07","2020-10-01","2021-02-08","2020-11-05","2021-02-08","2020-07-31","2020-01-02","2021-09-07","2020-02-28","2020-02-28","2021-08-19","2021-08-19"],"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":[["","68180072003","AMLODIPINE ","5MG","90","Select","Select",""],["","68180098103","LISINOPRIL ","20MG","90","Select","Select",""],["","00093727298","PIOGLITAZONE ","30MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","30","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","90","Select","Select",""],["","13668001105","CITALOPRAM ","40MG","30","Select","Select",""],["","50742061710","METOPROL ","100MG ER","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","69097081507","GABAPENTIN ","400MG","90","Select","Select",""],["","00193654621","BAYER ","LANCETS","100","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","1","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","59779045806","CVS ","10MG","90","Select","Select",""],["","68180072003","AMLODIPINE","5MG","90","Select","Select",""],["","68180098103","LISINOPRIL","20MG","90","Select","Select",""],["","13668001105","CITALOPRAM","40MG","30","Select","Select",""],["","69097081507","GABAPENTIN","400MG","90","Select","Select",""],["","50742061710","METOPROL","100MG ER","30","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","00093727298","PIOGLITAZONE","30MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","59651000305","OMEPRAZOLE","40MG","90","Select","Select",""],["","00193654621","BAYER","LANCETS","100","Select","Select",""],["","59779045806","CVS","10MG","90","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","1","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":""}]}]}