{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  LEAHCIMSNEWO D ","gend":0,"add":"OB O P813 X","city":"VANSANT","state":"VA","zip":"24656-0318","dob":"1998-08-06","age":"","mstatus":"","insh":"60017455","cliId":"","pno":"9567202627","cno":2765972620,"email":"","ename":"","eno":"","pphy":"POWERS, WILLIAM T","ppno":2769352080,"pcpadd":"1532 SLATE CREEK RD, SUITE 101","pcpcity":"GRUNDY","pcpstate":"VA","pcpzip":246146975,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"P O BOX 318","madd2":"                                                            ","madd3":"","mcity":"VANSANT","mstate":"VA","mzip":"24656-0318","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.039","E03.9","Z23","E55.9","D64.9","E83.42","L70.0","Q82.8","L02.425","L02.426","D48.5","Z00.129","J30.2","F84.0","L98.9","L70.9","K90.0","L91.0","R73.09"],"date":["2020-04-22","2020-10-07","2021-01-26","2020-10-07","2020-10-07","2020-10-07","2021-04-08","2019-11-15","2019-05-31","2019-05-31","2021-04-08","2019-05-08","2019-05-08","2020-10-07","2021-05-03","2020-10-07","2020-10-07","2019-11-15","2020-10-07"],"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":[["","00378363701","CETIRIZINE ","TAB 10MG","30","Select","Select",""],["","00074659490","SYNTHROID ","TAB 88MCG","15","Select","Select",""],["","00143980305","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","00574220120","TRETINOIN ","CRE 0.001","20","Select","Select",""],["","67405082508","BENZOYL ","LIQ 5% WASH","237","Select","Select",""],["","59762374401","CLINDAMYCIN ","LOT 10MG\/ML","60","Select","Select",""],["","00185067405","HYDROXYZ ","CAP 25MG","20","Select","Select",""],["","45802004064","SELENIUM ","LOT 0.025","120","Select","Select",""],["","63304061650","DOXYCYC ","CAP 100MG","60","Select","Select",""],["","13668048450","MINOCYCLINE ","CAP 100MG","60","Select","Select",""],["","60258015001","SF ","1.10%","102","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","",""],["No","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":""}]}]}