{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S RUHTRAEZTEUHC","gend":0,"add":"    EVIRD TSEROF NEERG   00841                              ","city":"COLONIAL HEIGHTS              ","state":"VA","zip":"23834-5832","dob":"1987-11-09","age":"","mstatus":"","insh":"30011970","cliId":"","pno":"2740819211","cno":"","email":"","ename":"","eno":"","pphy":"BECKWITH, DOUGLAS E                                         ","ppno":8047962373,"pcpadd":"12901 Briggs Rd,","pcpcity":"Chester                       ","pcpstate":"VA","pcpzip":238315335,"pcpcounty":"","pcpid":"","pcpname":"CHESTER FAMILY MEDCARE PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"14800 GREEN FOREST DRIVE","madd2":"                                                            ","madd3":"","mcity":"COLONIAL HEIGHTS              ","mstate":"VA","mzip":"23834-5832","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E78.6","E55.9","R00.0","R00.2","F25.9","F23","F30.9","Z91.11","F25.0","F41.1","F90.9","S80.869A","W57.XXXA"],"date":["2019-12-06","2019-12-06","2020-06-24","2020-06-24","2020-10-22","2020-10-22","2020-12-21","2020-12-21","2021-12-14","2021-11-22","2021-11-22","2021-11-22","2021-11-22"],"priorHcc":["","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","10147095303","PALIPERIDONE","TAB ER 6MG","60","Select","Select",""],["","51991029301","OXCARBAZEPIN","TAB 300MG","180","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","180","Select","Select",""],["","29300013901","DIVALPROEX","TAB 250MG DR","180","Select","Select",""],["","70436001002","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","68180061407","QUETIAPINE","TAB 200MG ER","90","Select","Select",""],["","13107008501","LORAZEPAM","TAB 2MG","90","Select","Select",""],["","10702001250","HYDROXYZ","TAB 50MG","30","Select","Select",""],["","00310028260","SEROQUEL","TAB 200MG","30","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","50458055401","INVEGA","TAB 1.5MG","90","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","45802006535","TRIAMCINOLON","CRE 0.005","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}