{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MADISON   R SADLER","gend":1,"add":"138  S 12TH AVENUE                                          ","city":"HOPEWELL                      ","state":"VA","zip":"23860-3749","dob":"2002-08-23","age":"","mstatus":"","insh":10100219,"cliId":"","pno":8049201484,"cno":8049201484,"email":"","ename":"","eno":"","pphy":"CLAY, JOHN                                                  ","ppno":"","pcpadd":"930 South Ave Ste 11","pcpcity":"Colonial Heights              ","pcpstate":"VA","pcpzip":238343620,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"APT A                                                       ","add3":"","madd1":"138  S 12TH AVENUE                                          ","madd2":"APT A                                                       ","madd3":"","mcity":"HOPEWELL                      ","mstate":"VA","mzip":"23860-3749","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S63.501A","S69.91XA","X50.0XXA","Y99.0","M41.84","M54.5","M41.9","M62.81","S91.332A","S99.922A","W25.XXXA","R50.9","J09.X2","Z20.828","J01.20","R09.81","J02.9","Z01.419","R30.0","Z11.3","N92.0","N39.0"],"date":["2019-04-25","2019-04-25","2019-04-25","2019-04-25","2019-07-05","2020-07-20","2019-07-05","2020-07-20","2019-10-03","2019-10-03","2019-10-03","2019-12-11","2019-12-11","2020-11-17","2020-11-17","2020-11-17","2020-11-17","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-11-09"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","",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":[]},{"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":[["","00430042014","LO","10\/1\/10","84","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","00430042014","LO ","TAB 40452","84","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","6","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","10","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","20","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":""}]}]}