{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NIAMRAHCREHTAR E","gend":1,"add":"                  734 XOB .O.P                              ","city":"CREWE                         ","state":"VA","zip":"23930-0437","dob":"1982-02-07","age":"","mstatus":"","insh":"50015800","cliId":"","pno":"9243401344","cno":"","email":"","ename":"","eno":"","pphy":"SPENCE, STEVEN N                                            ","ppno":4342927261,"pcpadd":"213 N Main St,","pcpcity":"Blackstone                    ","pcpstate":"VA","pcpzip":238241425,"pcpcounty":"","pcpid":"","pcpname":"BLACKSTONE FAMILY PRACTICE CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"P.O. BOX 437","madd2":"                                                            ","madd3":"","mcity":"CREWE                         ","mstate":"VA","mzip":"23930-0437","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.3","Z68.26","Z68.24","F20.0","Z72.0","F20.9","F25.9","F17.200","Z04.89","F29","R68.89","F23","Z87.891","E20.0","F17.210","Z79.899","E66.3","F25.0","F12.20","T20.00XA","F12.90"],"date":["2019-08-13","2019-06-04","2019-08-13","2020-08-21","2021-06-13","2021-09-24","2019-10-15","2019-12-23","2019-10-16","2019-10-16","2020-08-21","2019-12-22","2019-12-22","2019-12-29","2020-08-08","2020-08-08","2020-08-09","2021-06-15","2020-08-09","2021-06-13","2021-06-13"],"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":[["","65757040403","ARISTADA","INJ 1064MG","3.9","Select","Select",""],["","50458056401","INVEGA","INJ 234\/1.5","1.5","Select","Select",""],["","59148001871","ABILIFY","INJ 300MG","1","Select","Select",""],["","13668022030","ARIPIPRAZOLE","TAB 20MG","15","Select","Select",""],["","68382080701","TRAZODONE","TAB 150MG","15","Select","Select",""],["","55111053401","DIVALPROEX","TAB 500MG ER","15","Select","Select",""],["","10147095303","PALIPERIDONE","TAB ER 6MG","15","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":""}]}]}