{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ENNAYEHCDLONRA ","gend":1,"add":"NINNUD YGGEP O\/CRD KWAHWOM 027 G","city":"LYNCHBURG","state":"VA","zip":"24502-9998","dob":"2000-10-10","age":"","mstatus":"","insh":"68400210*37","cliId":"","pno":"38\/4349221-2","cno":"434\/832-1229","email":"","ename":"","eno":"","pphy":"RUSSELL, HORTENSE DO","ppno":"434\/200-7210","pcpadd":"16890 FOREST ROAD","pcpcity":"FOREST","pcpstate":"VA","pcpzip":24551,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","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":["F33.1","I62.00","S22.39XA","S27.329A","T14.8XXA","V89.2XXA","A08.4","Z20.828","V58.89","R10.11","T74.21XA","N92.6","S06.5X0A","S81.811A","S22.32XA","S01.01XA","M79.622","S61.412A","F17.210","V48.5XXA","Y92.410","F07.81","Z01.419","A64.","N89.8","NO DATA","R58.","S06.5X9A","V87.7XXA","Z48.02","F17.219"],"date":["2020-11-03","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2020-11-24","2020-11-24","2021-01-05","2021-11-29","2020-05-12","2020-04-01","2020-10-26","2020-11-05","2020-10-26","2020-10-26","2020-10-26","2020-11-05","2020-10-26","2020-10-26","2020-10-26","2020-11-02","2020-01-23","2020-01-23","2020-01-23","2020-01-23","2020-10-26","2020-11-05","2020-11-05","2020-11-05","2021-11-29"],"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":[["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","50580044936","TYLENOL","TAB 500MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","8","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":""}]}]}