{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELLIE DOBSON","gend":1,"add":"CULPEPER HUMAN SERVICES","city":"CULPEPER","state":"VA","zip":"22701-4140","dob":"1989-07-13","age":"","mstatus":"","insh":7460003,"cliId":"","pno":5406047470,"cno":5406044108,"email":"","ename":"","eno":"","pphy":"DEDWYLDER, ROSIER D","ppno":5406449505,"pcpadd":"5254 Potomac Dr, Ste C","pcpcity":"King George","pcpstate":"VA","pcpzip":224855832,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":5406044108,"add2":"1835 INDUSTRY DRIVE","add3":"","madd1":"CULPEPER HUMAN SERVICES","madd2":"1835 INDUSTRY DRIVE","madd3":"","mcity":"CULPEPER","mstate":"VA","mzip":"22701-4140","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.0","R10.9","R79.89","F19.10","F14.10","F11.10","R07.89","R11.2","I10","D63.8","K76.0","Z87.440","Z88.0","N12","R65.10","R94.5","R77.8","A41.9","I27.20","I36.1","I34.0","R31.9","R06.02","Z41.9","R07.9"],"date":["2020-03-28","2020-03-28","2020-03-28","2020-03-27","2020-03-28","2020-03-27","2020-03-28","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-03-26","2020-03-28","2020-03-26","2020-03-27","2020-03-26","2020-03-27","2020-03-27","2020-03-27","2020-03-27","2020-03-28","2020-03-28","2020-03-28","2020-03-28"],"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":[["","63304069301","CLINDAMYCIN ","CAP 300MG","28","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":""}]}]}