{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAVANNAH   D BALDWIN","gend":1,"add":"186 CHANDLER DRIVE","city":"TAZEWELL","state":"VA","zip":"24651-6156","dob":"2000-06-30","age":"","mstatus":"","insh":6815729,"cliId":"","pno":2762456960,"cno":2762456960,"email":"","ename":"","eno":"","pphy":"BRESOWAR, KRISTIN O","ppno":2769443999,"pcpadd":"13168 MEADOWVIEW SQUARE, ","pcpcity":"MEADOWVIEW","pcpstate":"VA","pcpzip":243610001,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","aligned":"","ano":"","add2":"LOT 9","add3":"","madd1":"186 CHANDLER DRIVE","madd2":"LOT 9","madd3":"","mcity":"TAZEWELL","mstate":"VA","mzip":"24651-6156","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O35.8XX0","Z34.83","Z3A.35","O99.334","Z37.0","F17.210","Z3A.39","O70.1","O26.899","Z39.1","Z34.82","Z3A.33","Z3A.28","B37.89","Z3A.32","O80","Z3A.30","Z3A.37","Z34.93","Z3A.38"],"date":["2020-06-23","2020-07-19","2020-06-23","2020-07-19","2020-07-20","2020-07-19","2020-07-20","2020-07-19","2020-07-19","2020-05-04","2020-05-04","2020-06-09","2020-04-30","2019-01-10","2020-05-28","2020-07-20","2020-05-14","2020-07-02","2020-07-03","2020-07-13"],"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":[["","00904759080","FEROSUL ","TAB 325MG","60","Select","Select",""],["","62332000131","FAMOTIDINE ","TAB 20MG","60","Select","Select",""],["","68001016208","PROMETHAZINE ","TAB 25MG","40","Select","Select",""],["","68462030329","HEATHER ","TAB 0.35MG","28","Select","Select",""],["","51672128902","NYSTATIN ","CRE 100000","30","Select","Select",""],["","64380080707","IBUPROFEN ","TAB 800MG","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":""}]}]}