{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HSIDGAJLETAP ","gend":0,"add":"LIHP 5702DAOR TTOP","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"1960-03-24","age":"","mstatus":"","insh":"5320210*70","cliId":"","pno":"9363356852","cno":"","email":"","ename":"","eno":"","pphy":"PATEL, BABITA B MD","ppno":4345175180,"pcpadd":"1129 N MAIN ST","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":"24592-9998","pcpcounty":"","pcpid":"","pcpname":"Halifax Internal Medicine, PLLC","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N28.1","K76.0","N39.0","R31.9","N30.01","Z00.00","Z12.5","E78.2","R93.1","R31.29","I49.3","I73.9","R93.422","N20.0","M85.9","R94.4"],"date":["2023-06-20","2023-06-20","2023-01-27","2023-01-27","2023-03-15","2023-01-26","2023-01-26","2023-05-24","2023-05-24","2023-03-02","2023-05-24","2023-05-24","2023-05-01","2023-05-01","2023-05-01","2023-05-01"],"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":[["","00093505998","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","65862007701","CIPROFLOXACIN HCL","500 MG","28","Select","Select",""],["","67877054360","CEFDINIR","300 MG","28","Select","Select",""],["","68645056259","IBUPROFEN","600 MG","30","Select","Select",""],["","65162068110","PHENAZOPYRIDINE HCL","100 MG","6","Select","Select",""],["","00143928501","AMOXICILLIN","875 MG","20","Select","Select",""],["","65162047810","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","14","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":""}]}]}