{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANTHONY   L PULLEN","gend":0,"add":"HARBOR POINT BEHAVIOR HEALTH--CS067                         ","city":"PORTSMOUTH                    ","state":"VA","zip":"23704-2221","dob":"2004-07-20","age":"","mstatus":"","insh":4448093,"cliId":"","pno":5404830879,"cno":5402936561,"email":"","ename":"","eno":"","pphy":"SHAH, MINESH R                                              ","ppno":4347994488,"pcpadd":"13908 Us Highway 29                                         ,                                                            ","pcpcity":"Chatham                       ","pcpstate":"VA","pcpzip":245313669,"pcpcounty":"","pcpid":"","pcpname":"DRMC FAMILY MEDICINE RESIDENCY CLINIC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"HARBOR POINT BEHAVIOR HEALTH--CS067                         ","add3":"","madd1":"HARBOR POINT BEHAVIOR HEALTH--CS067                         ","madd2":"301   FORT LANE                                             ","madd3":"","mcity":"PORTSMOUTH                    ","mstate":"VA","mzip":"23704-2221","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.10","F91.3","F90.0","F98.0","F33.1","G47.00","R45.4","Z00.8","F33.0","F90.2","Z13.9","Z20.828","F39","F34.81","F90.1","F91.2","F12.10","T76.12XA"],"date":["2020-07-02","2020-05-12","2020-05-12","2020-03-11","2020-07-02","2020-03-11","2020-02-25","2020-02-25","2020-05-13","2020-05-13","2020-05-27","2020-05-27","2020-07-02","2020-07-13","2020-07-02","2020-07-02","2020-07-02","2020-07-02"],"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":[["","13107003134","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","23155049001","DESMOPRESSIN","TAB 0.2MG","60","Select","Select",""],["","65162089903","ARIPIPRAZOLE","TAB 15MG","15","Select","Select",""],["","00832712315","DIVALPROEX","TAB 250MG DR","60","Select","Select",""],["","00078049305","FOCALIN","CAP 15MG","30","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":""}]}]}