{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEWART   C TORAIN","gend":0,"add":"3107 2ND AVE","city":"RICHMOND","state":"VA","zip":"23222-9998","dob":"1958-10-02","age":"","mstatus":"","insh":"20060047*01","cliId":"","pno":"804\/651-2075","cno":"804\/651-2075","email":"","ename":"","eno":"","pphy":"DOMAH, NAU DEAVIN MD","ppno":"804\/329-8510","pcpadd":"2421 CHAMBERLAYNE AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23222,"pcpcounty":"","pcpid":124812,"pcpname":"LABURNUM MEDICAL CENTER ","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","H61.23","H91.90","I67.89","I69.351","B18.2","I66.02","Z86.73","Z86.39","Z79.899","H90.0","E78.00","V58.89"],"date":["2020-12-08","2021-03-19","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-10-08","2020-10-08","2020-10-08","2021-03-19","2021-03-19","2020-08-18","2020-08-18"],"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":[["","00363015714","ASPIRIN ","325MG","30","Select","Select",""],["","55111012305","ATORVASTATIN ","40MG","30","Select","Select",""],["","68180098003","LISINOPRIL ","10MG","30","Select","Select",""],["","52817031910","BACLOFEN ","5MG","180","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","00363015714","ASPIRIN","325MG","30","Select","Select",""],["","52817031910","BACLOFEN","5MG","180","Select","Select",""],["","55111012305","ATORVASTATIN","40MG","90","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","58160088552","FLUARIX","2020-21","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":""}]}]}