{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAYLA   M ROSS","gend":1,"add":"1713 HARMON STREET                                          ","city":"NORFOLK                       ","state":"VA","zip":"23518-4130","dob":"1993-06-20","age":"","mstatus":"","insh":10256900,"cliId":"","pno":7573835372,"cno":7573835372,"email":"","ename":"","eno":"","pphy":"WELLS, JANELL                                               ","ppno":"","pcpadd":"9581 Shore Dr","pcpcity":"Norfolk                       ","pcpstate":"VA","pcpzip":235181711,"pcpcounty":"","pcpid":"P0151659","pcpname":"LITTLE CREEK FAMILY HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"TIDEWATER","aligned":"","ano":"","add2":"APARTMENT 203                                               ","add3":"","madd1":"1713 HARMON STREET                                          ","madd2":"APARTMENT 203                                               ","madd3":"","mcity":"NORFOLK                       ","mstate":"VA","mzip":"23518-4130","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","K63.89","R10.10","R11.10","R10.9","R10.0","R11.2","I49.8","K52.9","R10.11","N39.0","J18.9","U07.1","L50.0","R21","L29.9","Z91.013","Z97.5","T78.40XA","L50.9"],"date":["2021-04-27","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-30","2021-05-12","2021-05-06","2021-11-11","2021-11-13","2021-11-11","2021-11-13","2021-11-11","2021-11-11","2021-11-13"],"priorHcc":["","","","","","","","","","","","","",null,null,null,null,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":[["","59267100002","PFIZER","COVID-19","0.3","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","00603533932","PREDNISONE","20MG","21","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0.3","Select","Select",""],["","16714008210","HYDROXYZ ","TAB 25MG","30","Select","Select",""],["","59746017509","PREDNISONE ","TAB 20MG","6","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","20","Select","Select",""],["","66993001968","ALBUTEROL ","AER HFA","18","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","",""],["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":""}]}]}