{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  LEAHCIMSNEWO D ","gend":0,"add":"OB O P813 X","city":"VANSANT","state":"VA","zip":"24656-0318","dob":"1998-08-06","age":"","mstatus":"","insh":"60017455","cliId":"","pno":"9567202627","cno":"","email":"","ename":"","eno":"","pphy":"POWERS, WILLIAM T","ppno":2769352080,"pcpadd":"1532 SLATE CREEK RD, SUITE 101","pcpcity":"GRUNDY","pcpstate":"VA","pcpzip":246146975,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"P O BOX 318","madd2":"","madd3":"","mcity":"VANSANT","mstate":"VA","mzip":"24656-0318","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.039","E03.9","L70.9","K90.0","F84.0","D64.9","R73.09","E83.42","E55.9","Z23","D48.5","L70.0","L98.9","D22.9","Z87.2","J02.9","R22.1","R13.19","R05.1","K31.9","K22.9","Z00.129","J30.2","Q82.8","L02.425","L02.426","L91.0"],"date":["2020-04-22","2021-11-18","2020-10-07","2021-11-18","2021-11-18","2020-10-07","2020-10-07","2020-10-07","2020-10-07","2021-01-26","2021-04-08","2021-07-01","2021-05-03","2021-07-01","2021-07-01","2021-11-18","2021-11-18","2021-12-03","2021-12-03","2021-12-07","2021-12-07","2019-05-08","2019-05-08","2019-11-15","2019-05-31","2019-05-31","2019-11-15"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","45802004064","SELENIUM","LOT 0.025","120","Select","Select",""],["","60258015001","SF","CRE 0.011","102","Select","Select",""],["","00074659490","SYNTHROID","TAB 88MCG","30","Select","Select",""],["","67405082508","BENZOYL","LIQ 5% WASH","237","Select","Select",""],["","00574220120","TRETINOIN","CRE 0.001","20","Select","Select",""],["","59762374401","CLINDAMYCIN","LOT 10MG\/ML","60","Select","Select",""],["","13668048450","MINOCYCLINE","CAP 100MG","60","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","60","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","60","Select","Select",""],["","00185067405","HYDROXYZ","CAP 25MG","20","Select","Select",""],["","00378363701","CETIRIZINE","TAB 10MG","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":""}]}]}