{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEI NALLEY","gend":1,"add":"25525   OAK MEDLEY TERRACE                                  ","city":"ALDIE                         ","state":"VA","zip":"20105-2664","dob":"1967-08-25","age":"","mstatus":"","insh":10226277,"cliId":"","pno":5714650590,"cno":"","email":"","ename":"","eno":"","pphy":"RATCHFORD, FRANCIS X                                        ","ppno":"","pcpadd":"8640 Sudley Rd Ste 203,Ste 7","pcpcity":"Manassas                      ","pcpstate":"VA","pcpzip":201104404,"pcpcounty":"","pcpid":"P9443143","pcpname":"NOVANT HEALTH LAKE MANASSAS OBGYN","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"25525   OAK MEDLEY TERRACE                                  ","madd2":"                                                            ","madd3":"","mcity":"ALDIE                         ","mstate":"VA","mzip":"20105-2664","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["ASIAN\/PACIFIC"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","R87.810","R00.2","C73","Z98.890","E03.9","Z00.01","K21.9","M54.6","M54.2","Z63.0","Z62.1","Z12.31"],"date":["2020-02-24","2020-05-20","2021-01-05","2020-05-14","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-04-07"],"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":[["","69238183107","LEVOTHYROXIN","50MCG","30","Select","Select",""],["","64380080707","IBUPROFEN","800MG","20","Select","Select",""],["","59267100001","PFIZER","COVID-19","0.3","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","90","Select","Select",""],["","69238183107","LEVOTHYROXIN ","TAB 50MCG","30","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","20","Select","Select",""],["","62175061743","PANTOPRAZOLE ","TAB 40MG","90","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0.3","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":""}]}]}