{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TENESHA A HICKS","gend":1,"add":"2229 MOUNTAIN VIEW TERRACE SW APT 5 ","city":"ROANOKE  ","state":"VA","zip":"24015-9998","dob":"1991-04-08","age":"","mstatus":"","insh":11015375,"cliId":"2CE0D99XJ20","pno":5402789375,"cno":5402789375,"email":"","ename":"","eno":"","pphy":"LANTZ, JERI LYNN  ","ppno":5409858100,"pcpadd":"1030 S Jefferson St Ste 106","pcpcity":"Roanoke  ","pcpstate":"VA","pcpzip":240164418,"pcpcounty":"","pcpid":"P0117792","pcpname":"PARTRICK HENRY TEEN HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","ano":"","add2":"","add3":"","madd1":"5206 Lancelot Ln NW Apt 4  ","madd2":"","madd3":"","mcity":"Roanoke  ","mstate":"VA","mzip":"24019-3707","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Current Conditions \/ Suspect Codes","q":[{"a":{"diag":["Z20.828","Z30.42","Z30.011","Z72.0","Z00.00","Z68.26","Z20.822","F10.20","F63.81","F12.10","Z03.818"],"date":["2020-10-06","2020-09-17","2020-12-07","2020-12-10","2020-12-10","2020-12-10","2021-11-26","2021-09-13","2021-09-13","2021-09-13","2021-11-26"],"priorHcc":["","","","","","",null,null,null,null,null]}},{"a":[]}]},{"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":{"indx":["","",""],"comment":["","",""],"sub":[]}},{"a":{"indx":["","",""],"comment":["","",""],"sub":[]}}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","59762453802","MEDROXYPR AC","INJ 150MG\/ML","","Select","Select",""],["","555901658","SPRINTEC 28","TAB 28 DAY","","Select","Select",""],["","555901658","SPRINTEC ","TAB 28 DAY","84","Select","Select",""],["","59762453802","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","49483060450","IBUPROFEN ","800MG","18","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","84","Select","Select",""],["","68462030929","NORGEST\/ETHI","0.25\/35","84","Select","Select",""],["","49483060450","IBUPROFEN","800MG","18","Select","Select",""],["","59762453802","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","50111064801","FLUOXETINE","20MG","30","Select","Select",""],["","42806015905","HYDROXYZ","10MG","60","Select","Select",""],["","68462030929","NORGEST\/ETHI ","TAB 0.25\/35","84","Select","Select",""],["","42806015905","HYDROXYZ ","TAB 10MG","60","Select","Select",""],["","50111064801","FLUOXETINE ","CAP 20MG","30","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}