{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JORDAN KALEMWA","gend":0,"add":"4010   CANOPY WAY                                           ","city":"FREDERICKSBURG                ","state":"VA","zip":"22408-7748","dob":"2000-09-03","age":"","mstatus":"","insh":6717560,"cliId":"","pno":5407605546,"cno":"","email":"","ename":"","eno":"","pphy":"GUIRGUIS, EKRAM G                                           ","ppno":5407365043,"pcpadd":"4370 Starkey Rd                                             ,Ste 4A                                                      ","pcpcity":"Roanoke                       ","pcpstate":"VA","pcpzip":240180603,"pcpcounty":"","pcpid":"","pcpname":"MARY WASHINGTON HEALTHCARE PHYSICIANS","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"4010   CANOPY WAY                                           ","add3":"","madd1":"4010   CANOPY WAY                                           ","madd2":"                                                            ","madd3":"","mcity":"FREDERICKSBURG                ","mstate":"VA","mzip":"22408-7748","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","M79.672","Y93.67","M25.572","M25.472","M79.89","S93.402A","X50.1XXA","S93.602A","Z20.828","Z00.00","Z76.89","F12.159","F41.9","F12.20","F15.20","F19.94","R45.1","F41.1","F12.10","F90.9","I49.8","F29","Z20.822","F12.99","F17.209","F22","R94.31","F12.90","F17.200","M79.644","R22.31","R00.1","L02.511","S69.91XA","A64","B00.9","Z11.3","Z11.4","R76.0"],"date":["2020-02-27","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-11-07","2021-07-20","2021-07-20","2021-07-20","2021-08-20","2021-10-15","2021-10-15","2021-10-18","2021-11-01","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-19","2021-10-19","2021-10-19","2021-11-02","2021-11-02","2021-11-01","2021-11-01","2021-11-01","2021-11-02","2021-11-02","2021-11-02","2022-10-18","2021-11-02","2021-11-02","2021-11-02","2021-11-07","2021-11-07","2022-10-10","2022-11-08","2022-10-25","2022-10-25","2022-10-28"],"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":[["","24658031205","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","31722070430","VALACYCLOVIR","TAB 500MG","60","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","12","Select","Select",""],["","00536589588","NICOTINE","DIS 14MG\/24H","28","Select","Select",""],["","43547034006","RISPERIDONE","TAB 0.5MG","60","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","42806016105","HYDROXYZ","TAB 50MG","120","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":""}]}]}