{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  AHTABATEPRAHS K ","gend":1,"add":"                 tS dlareJ W 4                              ","city":"Highland Spgs                 ","state":"VA","zip":"23075-1337","dob":"1985-12-22","age":"","mstatus":"","insh":"50019960","cliId":"","pno":"3740863457","cno":"","email":"","ename":"","eno":"","pphy":"CROSSMAN, STEVEN H                                          ","ppno":8048285883,"pcpadd":"520 N 12th St Dept of,","pcpcity":"Richmond                      ","pcpstate":"VA","pcpzip":232985064,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"4 W JERALD STREET","madd2":"                                                            ","madd3":"","mcity":"HIGHLAND SPRING               ","mstate":"VA","mzip":"23075-1337","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F12.20","F14.20","F31.9","F43.10","F60.3","F11.10","F41.9","F41.1","F17.210","F19.10","F31.60","G47.00","I10","Z86.14","F31.0","F11.29","N61.1","N63.24","N76.0","B96.89","B19.20","A59.9","L03.213","H10.32","F19.90","R68.89","D75.1","K80.20","E83.52"],"date":["2021-12-13","2019-02-12","2019-02-12","2020-01-24","2019-02-14","2019-02-14","2019-03-07","2019-03-04","2019-03-04","2020-01-24","2019-03-06","2019-03-06","2019-03-07","2019-03-07","2019-03-06","2019-03-06","2019-03-29","2019-06-11","2019-06-11","2019-10-05","2019-10-05","2020-01-24","2020-08-16","2020-10-01","2020-10-01","2020-10-01","2021-02-28","2021-02-08","2020-12-18","2021-02-08"],"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":[["","24208031510","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","35573042030","ATOMOXETINE","CAP 80MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","14","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","1","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","28","Select","Select",""],["","60505024701","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","68382002101","VENLAFAXINE","TAB 75MG","30","Select","Select",""],["","29300016815","TIZANIDINE","TAB 2MG","1","Select","Select",""],["","50111043303","TRAZODONE","TAB 50MG","30","Select","Select",""],["","68180044701","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","10702001250","HYDROXYZ","TAB 50MG","20","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":""}]}]}