{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAYDEN ROBINS","gend":0,"add":"7906 PLEASANT POND LANE                                     ","city":"CHESTERFIELD                  ","state":"VA","zip":"23832-9206","dob":"2003-07-11","age":"","mstatus":"","insh":10174763,"cliId":"","pno":4348824514,"cno":4348824514,"email":"","ename":"","eno":"","pphy":"JACKSON, PAUL VERNON","ppno":"","pcpadd":"13540 Hull Street Rd","pcpcity":"Midlothian                    ","pcpstate":"VA","pcpzip":231122107,"pcpcounty":"","pcpid":"P0060023","pcpname":"ST FRANCIS FAMILY MEDICINE CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"7906 PLEASANT POND LANE                                     ","madd2":"                                                            ","madd3":"","mcity":"CHESTERFIELD                  ","mstate":"VA","mzip":"23832-9206","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.9","Z68.52","J40","Z23","J02.9","J01.90","S29.9XXA","V29.9XXA","S39.91XA","S09.90XA","S80.212A","M54.9","M25.562","M25.561","V23.4XXA","Y92.410","S80.211A","F17.290","S89.92XA","V89.2XXA","S39.92XA","R58"],"date":["2020-01-09","2020-01-09","2019-11-30","2020-07-29","2020-01-09","2020-01-09","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2021-06-23"],"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":[["","60505283503","ATOMOXETINE","80MG","30","Select","Select",""],["","65862050320","AMOX\/K","875-125","10","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","60505283503","ATOMOXETINE ","CAP 80MG","30","Select","Select",""],["","65862050320","AMOX\/K ","TAB 875-125","10","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","12","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":""}]}]}