{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NETSIRHCINOSAC ","gend":1,"add":"AORB 45101RD DROWSD","city":"BRISTOW","state":"VA","zip":"20136-9998","dob":"1983-08-06","age":"","mstatus":"","insh":"1412210*06","cliId":"","pno":"26\/1755918-0","cno":"","email":"","ename":"","eno":"","pphy":"WILLIAMS, RAENELL C MD","ppno":"571\/542-4950","pcpadd":"STE 170 4500 POND WAY","pcpcity":"WOODBRIDGE","pcpstate":"VA","pcpzip":22192,"pcpcounty":"","pcpid":"","pcpname":"SENTARA MEDICAL GROUP","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.0","F41.1","Z20.828","R68.83","K08.89","Z23.","Z00.00","Z11.1","R09.81","J30.9","J45.990","J06.9","R06.2","J02.9","K04.7","S90.121A","S61.411A","W26.8XXA","Y92.89","Y93.89","J32.9","F43.21","Z01.419","Z12.4","F32.81","Z88.3"],"date":["2019-12-26","2020-12-28","2021-02-04","2021-02-04","2019-11-18","2021-12-13","2020-11-19","2020-11-19","2021-04-01","2021-04-01","2021-04-01","2019-12-13","2019-10-01","2020-01-01","2020-06-19","2020-06-19","2020-02-01","2020-02-01","2020-02-01","2020-02-01","2021-02-03","2021-02-03","2021-08-12","2021-08-12","2021-08-12","2019-11-18"],"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":[["","00093227534","AMOX\/K","TAB 875-125","14","Select","Select",""],["","57237009960","CEFDINIR","CAP 300MG","20","Select","Select",""],["","59651021430","AZELASTINE","SPR 0.001","30","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","51672125801","CLOBETASOL","CRE 0.0005","45","Select","Select",""],["","69315090405","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","00096070760","DRYSOL","SOL 0.2","60","Select","Select",""],["","70000047001","BACITR","OIN 500\/GM","114","Select","Select",""],["","00054001825","PREDNISONE","TAB 20MG","12","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","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":""}]}]}