{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE   A WILSON","gend":1,"add":"2325 POCOSHOCK BLVD","city":"RICHMOND","state":"VA","zip":"23235-9998","dob":"1963-04-13","age":"","mstatus":"","insh":"20037634*01","cliId":"","pno":"804\/986-6999","cno":"804\/986-6999","email":"","ename":"","eno":"","pphy":"THOMAS, JOHNNA S MD","ppno":"434\/372-5141","pcpadd":"946 N MAIN ST","pcpcity":"CHASE CITY","pcpstate":"VA","pcpzip":23924,"pcpcounty":"","pcpid":105512,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"434\/430-0459","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/372-4814","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R11.2","R10.84","K50.00","J01.40","Z23.","Z68.38","K52.9","N39.0","R51.","M32.9","M19.072","M54.41","L29.9","R10.9","H81.11","M54.31","R42.","B35.1","M19.172","H60.91","M19.90","Z20.828","K56.7","I10.","Z87.891","Z88.2","Z90.49","Z79.84","Z79.899","E66.9","Z68.35","R10.33"],"date":["2020-06-15","2020-06-15","2020-06-15","2020-12-08","2020-12-08","2020-12-08","2020-06-15","2020-06-15","2020-06-15","2021-01-19","2020-03-17","2020-07-21","2020-08-05","2020-06-13","2020-11-30","2020-07-02","2021-01-19","2021-01-19","2020-07-21","2020-04-24","2020-04-24","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12","2020-06-12"],"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":[["","00378875006","DICLOFENAC ","1%","200","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","60","Select","Select",""],["","61314064511","NEO\/POLY\/HC ","1% OTIC","10","Select","Select",""],["","23155050105","HYDROXYZ ","25MG","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00527133001","BACLOFEN ","10MG","90","Select","Select",""],["","59746012206","MECLIZINE ","12.5MG","30","Select","Select",""],["","60505083305","AZELASTINE ","0.10%","30","Select","Select",""],["","68180071909","AMLODIPINE ","2.5MG","30","Select","Select",""],["","63481068447","VOLTAREN ","1%","100","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","60","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","68180071909","AMLODIPINE","2.5MG","30","Select","Select",""],["","59746012206","MECLIZINE","12.5MG","30","Select","Select",""],["","00527133001","BACLOFEN","10MG","90","Select","Select",""],["","00378875006","DICLOFENAC","1%","200","Select","Select",""],["","63481068447","VOLTAREN","1%","100","Select","Select",""],["","23155050105","HYDROXYZ","25MG","30","Select","Select",""],["","60505083305","AZELASTINE","0.10%","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","61314064511","NEO\/POLY\/HC","1% OTIC","10","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":""}]}]}