{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LETITIA   C HARRIS","gend":1,"add":"1620 LONE ST","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1982-10-27","age":"","mstatus":"","insh":"2183054*01","cliId":"","pno":"804\/798-2837","cno":"804\/798-2837","email":"","ename":"","eno":"","pphy":"KING, TONY R MD","ppno":"804\/230-4913","pcpadd":"1606 HULL ST STE A","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23224,"pcpcounty":"","pcpid":105617,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","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":["Z01.411","N93.8","D64.9","N91.2","D68.0","Z86.19","N93.9","D50.0","L03.213","F17.210","N85.4","H57.9","H57.10","Z11.59","R50.9","R05.","Z03.818"],"date":["2020-08-25","2020-08-25","2020-10-16","2020-08-25","2020-08-25","2020-08-25","2020-10-16","2020-04-17","2020-09-17","2020-04-16","2020-04-16","2020-09-17","2020-09-17","2020-10-14","2020-04-16","2020-04-16","2020-04-16"],"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":[["","00074366303","LUPRON ","11.25MG","1","Select","Select",""],["","68180016106","AZITHROMYCIN ","500MG","2","Select","Select",""],["","00536100901","FERROUS ","325MG","15","Select","Select",""],["","00904759060","FEROSUL ","325MG","15","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","28","Select","Select",""],["","45802086802","POLYETH ","3350 NF","238","Select","Select",""],["","00536106210","STOOL ","100MG","60","Select","Select",""],["","00406055201","OXYCODONE ","5MG","12","Select","Select",""],["","00904671980","ACETAMINOPHE ","325MG","120","Select","Select",""],["","67877032005","IBUPROFEN ","600MG","40","Select","Select",""],["","00536105224","PEG3350 ","","238","Select","Select",""],["","68180016106","AZITHROMYCIN","500MG","2","Select","Select",""],["","00904759060","FEROSUL","325MG","15","Select","Select",""],["","00074366303","LUPRON","11.25MG","1","Select","Select",""],["","00536100901","FERROUS","325MG","15","Select","Select",""],["","00536106210","STOOL","100MG","60","Select","Select",""],["","00904671980","ACETAMINOPHE","325MG","120","Select","Select",""],["","67877032005","IBUPROFEN","600MG","40","Select","Select",""],["","00536105224","PEG3350","","238","Select","Select",""],["","00406055201","OXYCODONE","5MG","12","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","28","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}