{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAITYLN   A AMBROSE","gend":1,"add":"P.O. BOX 92                                                 ","city":"MILLERS TAVERN                ","state":"VA","zip":"23115-0092","dob":"2001-08-30","age":"","mstatus":"","insh":10098964,"cliId":"","pno":8044434105,"cno":8044434105,"email":"","ename":"","eno":"","pphy":"BAND, SHARON R                                              ","ppno":"","pcpadd":"16 Delfae Dr","pcpcity":"WARSAW                        ","pcpstate":"VA","pcpzip":225724281,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"PO BOX 92                                                   ","add3":"","madd1":"P.O. BOX 92                                                 ","madd2":"PO BOX 92                                                   ","madd3":"","mcity":"MILLERS TAVERN                ","mstate":"VA","mzip":"23115-0092","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.81","J30.1","J30.89","Z91.018","T78.40XA","J45.990","R63.5","Z23","R59.1","H92.02","R22.1","N91.5","R59.0","E22.1","Z00.00","T78.40XD","L08.9","N81.84","M41.9"],"date":["2020-07-16","2020-07-16","2020-06-12","2019-06-20","2019-06-20","2020-02-10","2019-08-14","2021-04-28","2019-11-01","2020-02-10","2020-05-15","2021-01-19","2021-01-19","2021-01-21","2021-04-22","2021-04-22","2021-06-18","2021-03-08","2021-03-08"],"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":[["","62332025050","DOXYCYC","100MG","14","Select","Select",""],["","53746051401","SPIRONOLACT","50MG","30","Select","Select",""],["","68462072029","DROSPIRENONE","ETHY EST","84","Select","Select",""],["","59762374301","CLINDAMYCIN","1%","30","Select","Select",""],["","49502050002","EPIPEN","0.3MG","2","Select","Select",""],["","68462072029","DROSPIRENONE ","TAB ETHY EST","84","Select","Select",""],["","62332025050","DOXYCYC ","CAP 100MG","14","Select","Select",""],["","53746051401","SPIRONOLACT ","TAB 50MG","30","Select","Select",""],["","59762374301","CLINDAMYCIN ","GEL 0.01","30","Select","Select",""],["","49502050002","EPIPEN ","INJ 0.3MG","2","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}