{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUB W BELACNOTNUD-DROF","gend":0,"add":"OB OP144 X","city":"BLOXOM","state":"VA","zip":23308,"dob":"1998-07-23","age":"","mstatus":"","insh":"40012017","cliId":"","pno":"6675756365","cno":"","email":"","ename":"","eno":"","pphy":"STARK, HEATHER R","ppno":7576656365,"pcpadd":"20306 BADGER LN,","pcpcity":"ONANCOCK","pcpstate":"VA","pcpzip":23417,"pcpcounty":"","pcpid":"","pcpname":"ONLEY COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"PO BOX 441","add3":"","madd1":"PO BOX 441","madd2":"                                                            ","madd3":"","mcity":"BLOXOM                        ","mstate":"VA","mzip":"23308-0441","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F84.0","E11.9","J02.9","Z68.54","Z68.31","R06.02","E11.65","Z83.3","H40.011","H52.13","H52.523","Z91.81","R25.9","T78.40XA","E66.09","Z68.32","J01.01","E11.69","E78.5","Z28.21","J02.0","R47.9","F80.1","J30.2","J45.909","K75.81","Z79.84","Z79.2","Z03.818","Z23","Z92.29","H40.013"],"date":["2021-05-01","2021-07-02","2019-10-02","2019-01-18","2019-01-18","2019-02-25","2021-05-01","2019-05-01","2019-05-29","2019-05-29","2021-07-02","2019-09-12","2019-09-12","2019-09-12","2021-05-01","2021-05-01","2019-10-02","2019-12-30","2021-05-01","2019-12-30","2020-02-20","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2021-05-01","2020-11-01","2021-05-01","2021-04-29","2021-07-01","2021-07-01","2021-07-02"],"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":[["","70377000415","SIMVASTATIN","TAB 40MG","90","Select","Select",""],["","64980028001","GLIPIZIDE","TAB 5MG","90","Select","Select",""],["","43547034206","RISPERIDONE","TAB 2MG","180","Select","Select",""],["","65862049301","QUETIAPINE","TAB 200MG","45","Select","Select",""],["","67877056310","METFORMIN","TAB 1000MG","180","Select","Select",""],["","60505025801","DESMOPRESSIN","TAB 0.2MG","60","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","270","Select","Select",""],["","57237010601","DIVALPROEX","TAB 125MG DR","540","Select","Select",""],["","00093226401","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00093317431","ALBUTEROL","FAT E HFA INH","17","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","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":""}]}]}