{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CANDACE   L THOMAS","gend":1,"add":"17482 JAMES RIVER DR","city":"DISPUTANTA","state":"VA","zip":"23842-9998","dob":"1957-03-30","age":"","mstatus":"","insh":"1331594*01","cliId":"","pno":"804\/458-1124","cno":"804\/458-1124","email":"","ename":"","eno":"","pphy":"DABHI, KISHOR S MD","ppno":"804\/526-5850","pcpadd":"3628 BULEVARD","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":23834,"pcpcounty":"","pcpid":117891,"pcpname":"Swift Creek Family Care","plan":"OHP","program":"ACA","lob":"Small Group","region":"CENTRAL","aligned":"","ano":"804\/837-6642","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/520-7312","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.0","G24.4","Z12.11","Z20.828","R09.81","J01.90","Z76.89","M25.562","S83.282D","M77.12","M25.522","M62.81","M77.02","Z23.","Z13.820","Z78.0","M85.89","L57.8","L73.8","L82.1","D18.01","L72.0","Z01.419","Z12.31","Z00.00","M85.88","E55.9","G24.9","Z79.899","J01.10","M54.2","M54.5","S39.012D","R29.898","Z12.12","I10.","Z12.72","M43.8X6","M54.59","G89.29"],"date":["2020-04-02","2021-03-22","2021-08-30","2020-09-27","2020-09-27","2020-09-27","2020-09-27","2020-10-19","2020-11-04","2021-04-08","2020-11-06","2021-04-08","2020-10-06","2021-02-06","2021-06-24","2021-06-24","2021-06-24","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2020-05-20","2021-08-26","2021-08-26","2021-10-04","2021-10-04","2021-10-04","2021-03-25","2021-03-25","2020-10-21","2021-11-09","2021-09-15","2021-09-15","2021-09-15","2021-08-26","2021-08-26","2021-08-26","2021-08-31","2021-11-09","2021-11-09"],"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":[["","00228253996","CARB\/LEVO","25-100MG","450","Select","Select",""],["","69097083305","SERTRALINE","25MG","90","Select","Select",""],["","68180065208","DOXYCYC","100MG","14","Select","Select",""],["","00378064110","PREDNISONE","10MG","6","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","00228253996","CARB\/LEVO ","25-100MG","450","Select","Select",""],["","69097083305","SERTRALINE ","25MG","90","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","10","Select","Select",""],["","68180065208","DOXYCYC ","100MG","14","Select","Select",""],["","00378064205","PREDNISONE ","20MG","10","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","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","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}