{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARSON   N GAIMARI","gend":0,"add":"86 POTTERS POND LANE                                        ","city":"COBBS CREEK                   ","state":"VA","zip":"23035-2129","dob":"2002-07-05","age":"","mstatus":"","insh":10213036,"cliId":"","pno":8047258374,"cno":8047258374,"email":"","ename":"","eno":"","pphy":"RANSONE JR, STERLING                                        ","ppno":"","pcpadd":"500 J Clyde Morris Blvd # Ref","pcpcity":"Newport News                  ","pcpstate":"VA","pcpzip":236011929,"pcpcounty":"","pcpid":"P9058650","pcpname":"FISHING BAY FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"86 POTTERS POND LANE                                        ","madd2":"                                                            ","madd3":"","mcity":"COBBS CREEK                   ","mstate":"VA","mzip":"23035-2129","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.9","F43.10","R45.851","F41.9","F31.9","X78.9XXA","F33.1","S51.811A","Z88.6","Z88.0","Z91.013","Z91.5"],"date":["2020-06-03","2020-05-20","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-05-17","2020-05-17"],"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":[["","00093317431","ALBUTEROL","E","8.5","Select","Select",""],["","62756079788","DIVALPROEX","250MG DR","90","Select","Select",""],["","69097091707","BUPROPION","75MG","60","Select","Select",""],["","68180032002","BUPROPN","300MG XL","30","Select","Select",""],["","59762531001","PRAZOSIN","1MG","30","Select","Select",""],["","00093742698","MONTELUKAST","10MG","90","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","62756079788","DIVALPROEX ","TAB 250MG DR","90","Select","Select",""],["","69097091707","BUPROPION ","TAB 75MG","60","Select","Select",""],["","68180032002","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","59762531001","PRAZOSIN ","CAP 1MG","30","Select","Select",""],["","00093742698","MONTELUKAST ","TAB 10MG","90","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":""}]}]}