{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AHSILALLENNOB","gend":1,"add":"KAO 3141DAOR SE","city":"KENBRIDGE","state":"VA","zip":"23944-9998","dob":"1995-04-05","age":"","mstatus":"","insh":"5927774","cliId":"","pno":"1904521810","cno":5409101812,"email":"","ename":"","eno":"","pphy":"HOLLAND, JOHN A","ppno":4346962165,"pcpadd":"1508 K V Rd, ","pcpcity":"Victoria","pcpstate":"VA","pcpzip":239742624,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1413 OAKES ROAD","madd2":"                                                            ","madd3":"","mcity":"KENBRIDGE","mstate":"VA","mzip":"23944-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23","Z3A.27","O33.8","O76","O77.0","Z3A.39","Z37.0","Z34.80","Z34.03","Z3A.38","Z39.2","M54.5","L76.33","F17.210","F41.9","Z30.42","Z34.93","Z3A.32","Z36.3","Z3A.23","O26.893","Z3A.33","O26.843","O77.9","O65.4","Z3A.34","Z3A.37","O86.00","A41.9","F41.1","N91.2","Z33.1","O14.93","F90.0","O47.1","O62.2","O99.324","D62","O99.214","E66.01","F12.90","O99.334","O99.344","F32.9"],"date":["2020-05-26","2020-05-26","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-06-29","2020-08-10","2020-08-15","2020-08-24","2020-08-24","2020-08-24","2021-02-04","2021-02-04","2021-03-10","2020-08-06","2020-06-29","2020-04-16","2020-04-16","2020-07-10","2020-07-10","2020-08-06","2020-08-17","2020-08-17","2020-07-16","2020-08-06","2020-08-26","2020-08-26","2020-07-31","2020-03-25","2020-03-25","2020-08-05","2021-02-04","2020-08-15","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17"],"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":[["","65862018601","CLINDAMYCIN ","CAP 300MG","9","Select","Select",""],["","68382005105","MELOXICAM ","TAB 15MG","7","Select","Select",""],["","43547028111","ESCITALOPRAM ","TAB 10MG","90","Select","Select",""],["","00548570100","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","62332002431","FLUOXETINE ","CAP 40MG","90","Select","Select",""],["","68645052354","SERTRALINE ","TAB 100MG","90","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","",""],["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":""}]}]}