{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT   E WILLIAMS","gend":0,"add":"645 WESTOVER HILLS BLVD APT G","city":"RICHMOND","state":"VA","zip":"23225-9998","dob":"1964-10-10","age":"","mstatus":"","insh":"20061265*01","cliId":"","pno":"804\/939-0041","cno":"804\/939-0041","email":"","ename":"","eno":"","pphy":"DIPASQUALE-SEELIG, KATHLEEN MD","ppno":"804\/292-3011","pcpadd":"180 EAST BELT DRIVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23224,"pcpcounty":"","pcpid":131762,"pcpname":"","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":["F33.3","R10.13","I49.3","I50.30","J44.9","H53.9","Z87.898","I45.10","R60.0","I10.","R19.5","K40.90","F17.200","I11.0","F17.210","F12.10","I77.810","R10.9","E78.5","R93.1","R06.02","I44.0","R06.00","D31.90","H52.13","Z79.899","S62.001A"],"date":["2020-08-11","2020-10-07","2020-10-08","2021-04-19","2021-04-19","2021-04-19","2021-04-19","2021-04-03","2020-10-09","2021-07-14","2020-10-08","2020-10-08","2021-07-14","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2021-06-23","2021-04-07","2021-04-07","2021-04-07","2021-07-14","2020-10-08","2021-07-14","2021-07-14","2021-07-14","2021-08-16"],"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":[["","23155000310","HYDRALAZINE ","50MG","90","Select","Select",""],["","16729018317","HYDROCHLOROT ","25MG","30","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30","Select","Select",""],["","29300034910","ALLOPURINOL ","100MG","30","Select","Select",""],["","60505257908","ATORVASTATIN ","20MG","90","Select","Select",""],["","76385011150","CARVEDILOL ","6.25MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","20","Select","Select",""],["","71093014105","METHOCARBAM ","750MG","15","Select","Select",""],["","23155000810","HYDROCHLOROT","25MG","30","Select","Select",""],["","23155000301","HYDRALAZINE","50MG","90","Select","Select",""],["","68382009505","CARVEDILOL","25MG","180","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","71093014105","METHOCARBAM","750MG","15","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","6","Select","Select",""],["","67877032105","IBUPROFEN","800MG","20","Select","Select",""],["","29300034910","ALLOPURINOL","100MG","30","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":""}]}]}