{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARCUS   D JACKSON","gend":0,"add":"10432   KING  ROAD                                          ","city":"KING GEORGE                   ","state":"VA","zip":"22485-3318","dob":"2000-06-30","age":"","mstatus":"","insh":10233249,"cliId":"","pno":5402739386,"cno":5402739386,"email":"","ename":"","eno":"","pphy":"DEDWYLDER, ROSIER D                                         ","ppno":"","pcpadd":"5254 Potomac Dr","pcpcity":"King George                   ","pcpstate":"VA","pcpzip":224855832,"pcpcounty":"","pcpid":"P0149790","pcpname":"MARY WASHINGTON MEDICAL GROUP","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"10432   KING  ROAD                                          ","madd2":"                                                            ","madd3":"","mcity":"KING GEORGE                   ","mstate":"VA","mzip":"22485-3318","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.01","Z01.89","Z71.3","Z13.31","E66.8","F84.0","Z01.00","Z13.6","Z13.29","Z13.21","Z13.1","D69.6","Z71.2","Z71.89","L73.2","L83","Z13.220","D75.9","D70.9","D69.3"],"date":["2021-06-24","2021-06-24","2020-06-23","2021-06-24","2020-06-23","2020-06-23","2020-06-23","2020-06-26","2021-06-24","2020-06-26","2021-06-24","2021-12-01","2020-07-18","2021-06-24","2021-08-02","2021-03-04","2021-06-24","2021-06-24","2021-12-01","2021-12-01"],"priorHcc":["","","","","","","","","","","",null,"","","","","","",null,null]}},{"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":[["","68180044102","CEPHALEXIN","250\/5ML","400","Select","Select",""],["","00093101042","MUPIROCIN","2%","22","Select","Select",""],["","50428041228","SKIN","4%","237","Select","Select",""],["","50428034792","NON-STICK","3\"X4\"","30","Select","Select",""],["","00054317644","DEXAMETHASON","1MG\/ML","160","Select","Select",""],["","53489011905","DOXYCYCL","100MG","30","Select","Select",""],["","68180044102","CEPHALEXIN ","SUS 250\/5ML","400","Select","Select",""],["","00093101042","MUPIROCIN ","OIN 0.02","22","Select","Select",""],["","50428041228","SKIN ","SOL 0.04","237","Select","Select",""],["","50428034792","NON-STICK ","PAD 3\"X4\"","30","Select","Select",""],["","00054418425","DEXAMETHASON ","TAB 4MG","40","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","30","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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}