{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRYSTAL   M MCDANIEL","gend":1,"add":"3790 IMPALA DRIVE                                           ","city":"PRINCE GEORGE                 ","state":"VA","zip":"23875-1492","dob":"1996-03-27","age":"","mstatus":"","insh":10030095,"cliId":"","pno":8044585735,"cno":8044585735,"email":"","ename":"","eno":"","pphy":"GADANI, MANU R                                              ","ppno":"","pcpadd":"5303 Plaza Dr,2116 W Laburnum Ave Ste 100","pcpcity":"Hopewell                      ","pcpstate":"VA","pcpzip":238607331,"pcpcounty":"","pcpid":"P0060202","pcpname":"MANU GADANI MD PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"3790 IMPALA DRIVE                                           ","madd2":"                                                            ","madd3":"","mcity":"PRINCE GEORGE                 ","mstate":"VA","mzip":"23875-1492","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","I10","E28.2","K76.0","E28.8","Z68.36","E25.9","Z68.35"],"date":["2020-06-15","2020-06-15","2019-11-05","2019-11-05","2020-06-15","2019-11-05","2020-06-15","2020-06-15"],"priorHcc":["","","","","","","",""]}},{"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":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","62332025118","AZITHROMYCIN","250MG","6","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","60258015001","SF","1.10%","51","Select","Select",""],["","58160088752","FLUARIX ","INJ 2021-22","0.5","Select","Select",""],["","62332025118","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00603533815","PREDNISONE ","PAK 10MG","21","Select","Select",""],["","60258015001","SF ","CRE 0.011","51","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}