{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EMILY   C HYNSON","gend":1,"add":"9076 COTTLESTON CIR","city":"MECHANICSVILLE","state":"VA","zip":"23116-9998","dob":"1998-03-16","age":"","mstatus":"","insh":"1585660*04","cliId":"","pno":"804\/550-1962","cno":"804\/550-1962","email":"","ename":"","eno":"","pphy":"TERRY, CHARLES MD","ppno":"804\/754-3776","pcpadd":"10410 RIDGEFIELD PKWY","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23233,"pcpcounty":"","pcpid":100329,"pcpname":"RVA Pediatrics","plan":"OHP","program":"ACA","lob":"Small Group","region":"CENTRAL","aligned":"","ano":"804\/798-2924","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","U07.1","R50.9","Z00.00","Z20.828","J01.10","J45.20","D22.62","D22.5","L70.0","Z23.","Z68.22","R82.90","Z11.3","Z30.9","Z80.3","Z20.2","N89.8","Z11.2"],"date":["2021-07-21","2020-11-15","2020-11-15","2020-09-03","2020-11-15","2020-01-28","2020-01-28","2020-09-09","2020-09-09","2020-09-09","2020-09-03","2020-09-03","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-07-21","2021-07-21"],"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":[["","00054327099","FLUTICASONE ","50MCG","-16","Select","Select",""],["","65862050320","AMOX\/K ","875-125","14","Select","Select",""],["","00555901658","SPRINTEC ","28 DAY","84","Select","Select",""],["","31722070530","VALACYCLOVIR ","1GM","4","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","-16","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","00555901658","SPRINTEC","28 DAY","84","Select","Select",""],["","31722070530","VALACYCLOVIR","1GM","4","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","68462030929","NORGEST\/ETHI","0.25\/35","84","Select","Select",""],["","47781030301","NITROFURANTN ","CAP 100MG","10","Select","Select",""],["","68462030929","NORGEST\/ETHI ","TAB 0.25\/35","84","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","",""],["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":""}]}]}