{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID SANCHEZ","gend":0,"add":"3510 CARLYLE COURT","city":"FREDERICKSBURG                ","state":"VA","zip":"22408-9237","dob":"2004-07-11","age":"","mstatus":"","insh":4188840,"cliId":"","pno":5403611363,"cno":"","email":"","ename":"","eno":"","pphy":"HENRY, NELSON","ppno":5407410537,"pcpadd":"10620 Spotsylvania Ave,","pcpcity":"Fredericksburg                ","pcpstate":"VA","pcpzip":224082637,"pcpcounty":"","pcpid":"","pcpname":"MARY WASHINGTON HEALTHCARE PHYSICIANS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"3510 CARLYLE COURT","add3":"","madd1":"3510 CARLYLE COURT","madd2":"","madd3":"","mcity":"FREDERICKSBURG                ","mstate":"VA","mzip":"22408-9237","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J01.90","J30.9","J30.1","J30.2","J30.89","J30.81","Z51.6","Z00.121","F41.1","F32.1","K59.00","M94.0","F33.0","K59.01","R33.9","F41.9","R39.11","R33.0","I10","E66.9","R03.0","J02.9","J02.0","R11.0","E80.7","K21.9","R07.9"],"date":["2020-02-20","2021-05-19","2020-03-18","2020-03-18","2020-03-18","2020-03-18","2020-10-14","2020-07-24","2021-06-10","2021-06-10","2020-09-04","2020-08-19","2021-06-15","2020-08-27","2020-09-07","2021-01-15","2020-09-03","2020-09-14","2021-06-08","2021-03-14","2021-06-05","2021-06-08","2021-06-05","2021-06-05","2021-06-05","2021-08-17","2021-08-17"],"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":[["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59779087426","ALLERGY","LIQ 12.5\/5ML","118","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00574110404","BROM\/PSE\/DM","SYP ","160","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0.3","Select","Select",""],["","08290324912","INSULIN","MIS 1ML\/31G","10","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","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":""}]}]}