{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"URC ACIREATSOCA-Z","gend":1,"add":"ISARF 203EVIRD RE","city":"STAFFORD","state":"VA","zip":"22556-8028","dob":"2001-03-17","age":"","mstatus":"","insh":"9028155","cliId":"","pno":"1374338226","cno":"","email":"","ename":"","eno":"","pphy":"REID, YOLANDA","ppno":5406592111,"pcpadd":"95 DUNN DR STE 123,","pcpcity":"Stafford","pcpstate":"VA","pcpzip":"22556-1503","pcpcounty":"","pcpid":"","pcpname":"PRATT MEDICAL CENTER LTD","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"302 FRASIER DRIVE","add3":"","madd1":"302 FRASIER DRIVE","madd2":"","madd3":"","mcity":"STAFFORD","mstate":"VA","mzip":"22556-8028","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G80.9","G40.909","K21.9","R39.81","R15.9","R31.9","Z99.3","E43","P35.1","Z86.19","G80.0","R06.02","Z20.822","U07.1","Z96.60","R09.81","F79","K05.10","R56.9","K05.00","L50.9","R21","G40.011","G82.50","K06.1"],"date":["2023-05-30","2022-10-26","2021-06-29","2023-04-12","2023-04-12","2023-04-12","2023-04-12","2021-06-29","2021-06-29","2021-10-07","2022-05-10","2021-12-26","2021-12-26","2022-01-03","2021-12-26","2022-01-03","2022-01-03","2022-10-26","2022-10-26","2022-10-29","2022-10-29","2022-10-29","2022-11-01","2022-11-01","2022-11-01"],"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":[["","69097012403","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","70700026330","LANSOPRAZOLE","CAP 30MG DR","30","Select","Select",""],["","16571067450","PHENOBARB","TAB 60MG","60","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","56","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","14","Select","Select",""],["","68682065220","DIAZEPAM","GEL 10MG","1","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":""}]}]}