{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHEYANNE   M VICK","gend":1,"add":"29422 CLARKSBURY ROAD                                       ","city":"BOYKINS                       ","state":"VA","zip":"23827-2437","dob":"2002-04-08","age":"","mstatus":"","insh":10100424,"cliId":"","pno":7578990046,"cno":4345942382,"email":"","ename":"","eno":"","pphy":"MARIA M ONA MD PC                                           ","ppno":"","pcpadd":"931 Armory Dr Ste C","pcpcity":"Franklin                      ","pcpstate":"VA","pcpzip":238511879,"pcpcounty":"","pcpid":"P9307396","pcpname":"MARIA M ONA MD PC","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"29422 CLARKSBURY ROAD                                       ","madd2":"                                                            ","madd3":"","mcity":"BOYKINS                       ","mstate":"VA","mzip":"23827-2437","pcpfaxno":7575624233,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J32.0","J32.1","J32.2","J32.3","J45.990","F43.20","F41.1","F40.10","F90.0","F90.2","F41.9","J30.1","H61.23","L50.0","T78.40XA","Z79.899","Z88.0","F90.9","Z72.89","S50.812A","R45.851","X78.1XXA","R63.6","Z91.5","Z20.828"],"date":["2020-03-03","2020-03-03","2020-03-03","2019-02-06","2019-04-04","2019-08-30","2020-10-14","2020-10-14","2020-10-14","2019-09-24","2019-09-24","2020-07-24","2020-07-24","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2020-04-16","2021-01-14"],"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":[["","50458058601","CONCERTA","36MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN","500MG","14","Select","Select",""],["","00115169449","EPINEPHRINE","0.3MG","2","Select","Select",""],["","42806016001","HYDROXYZ","25MG","20","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","10","Select","Select",""],["","59762444002","METHYLPRED","4MG","21","Select","Select",""],["","50458058601","CONCERTA ","TAB 36MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN ","TAB 500MG","14","Select","Select",""],["","00115169449","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","42806016001","HYDROXYZ ","TAB 25MG","20","Select","Select",""],["","65862085901","FAMOTIDINE ","TAB 20MG","10","Select","Select",""],["","59762444002","METHYLPRED ","TAB 4MG","21","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":""}]}]}