{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AUHSOJHTUDDUS P","gend":0,"add":"        DAOR EVORG ENIP   0833                              ","city":"STANLEY                       ","state":"VA","zip":"22851-5411","dob":"1996-07-10","age":"","mstatus":"","insh":"50018024","cliId":"","pno":"4704504452","cno":5402441390,"email":"","ename":"","eno":"","pphy":"WENGER, JOHN D                                              ","ppno":5404332554,"pcpadd":"1661 S Main St,","pcpcity":"Harrisonburg                  ","pcpstate":"VA","pcpzip":228012728,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"3380 PINE GROVE ROAD","madd2":"                                                            ","madd3":"","mcity":"STANLEY                       ","mstate":"VA","mzip":"22851-5411","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.009","J01.80","E66.3","F84.0","E66.9","F90.9","F41.9","R46.81","G47.9","S01.81XA","S69.92XA","S52.124A","S52.121A","S01.21XA","Z23","W19.XXXA","Y93.02","S59.901A","T07.XXXA","W17.81XA","S42.124D","S52.124D","L08.89","R21","S52.121D","Z79.899","Z51.81","R09.81","J32.1","R04.0","Z88.9","T78.40XD","R41.840"],"date":["2021-10-04","2021-12-13","2019-05-21","2021-06-07","2019-05-21","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2019-09-14","2019-09-14","2019-09-26","2019-09-14","2019-09-14","2021-10-04","2019-09-14","2019-09-14","2019-09-14","2019-09-19","2019-09-26","2019-10-10","2019-10-31","2019-10-17","2019-10-18","2019-10-31","2020-05-19","2020-05-19","2021-10-04","2021-03-17","2021-03-17","2021-03-17","2021-06-07","2021-06-07"],"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":[["","65862001305","SERTRALINE","TAB 100MG","60","Select","Select",""],["","68001023703","CLONIDINE","TAB 0.1MG","105","Select","Select",""],["","43547034406","RISPERIDONE","TAB 4MG","60","Select","Select",""],["","29300024401","BUSPIRONE","TAB 5MG","120","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","46122044062","GNP","CAP 25MG","60","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","00603533932","PREDNISONE","TAB 20MG","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":""}]}]}