{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATHAN   H MULLINS","gend":0,"add":"962 DEVINE DRIVE                                            ","city":"STRASBURG                     ","state":"VA","zip":"22657-2854","dob":"2003-07-08","age":"","mstatus":"","insh":10183493,"cliId":"","pno":5403332335,"cno":"","email":"","ename":"","eno":"","pphy":"HOLTHUS, THOMAS E                                           ","ppno":"","pcpadd":"33674 Old Valley Pike","pcpcity":"Strasburg                     ","pcpstate":"VA","pcpzip":226573704,"pcpcounty":"","pcpid":"P9409324","pcpname":"PEDIATRIC ASSOCIATES OF WINCHESTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"962 DEVINE DRIVE                                            ","madd2":"                                                            ","madd3":"","mcity":"STRASBURG                     ","mstate":"VA","mzip":"22657-2854","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","R45.1","R45.851","F39","F43.9","F33.2","Z11.59","F32.1","Z00.129","Z23","Z68.54","F99","F33.1","F41.9","Z79.899","Z20.822"],"date":["2020-06-17","2019-08-02","2020-06-09","2020-06-17","2020-06-17","2020-06-09","2020-06-09","2020-06-17","2020-06-19","2020-06-19","2020-06-19","2021-07-22","2021-10-22","2021-10-22","2021-07-22","2021-10-14"],"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":[["","65862001105","SERTRALINE","25MG","30","Select","Select",""],["","00185041501","BUPROPION","150MG SR","60","Select","Select",""],["","65862001105","SERTRALINE ","TAB 25MG","30","Select","Select",""],["","00185041501","BUPROPION ","TAB 150MG SR","60","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":""}]}]}