{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRANDY PETERSON","gend":1,"add":"9807 HIGHWAY ONE","city":"SOUTH HILL","state":"VA","zip":"23970-9998","dob":"1983-07-16","age":"","mstatus":"","insh":"1630110*01","cliId":"","pno":"434\/774-5658","cno":"434\/774-5658","email":"","ename":"","eno":"","pphy":"HIVELY, JEFFREY W MD","ppno":"434\/374-5344","pcpadd":"115 COLLEGE ST","pcpcity":"CLARKSVILLE","pcpstate":"VA","pcpzip":23927,"pcpcounty":"","pcpid":105511,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/374-4814","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.9","J02.9","Z68.27","J01.00","Z23.","J01.90"],"date":["2020-11-10","2020-11-10","2020-11-10","2020-01-25","2021-06-25","2021-09-04"],"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":[["","00555901658","SPRINTEC","28 DAY","84","Select","Select",""],["","00591544310","PREDNISONE","20MG","21","Select","Select",""],["","64980030550","DENTA","PLUS","153","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","65162052110","PROMETHAZINE","25MG","10","Select","Select",""],["","49483060450","IBUPROFEN","800MG","20","Select","Select",""],["","00126028666","PREVIDENT","5000 PLS","153","Select","Select",""],["","00555901658","SPRINTEC ","28 DAY","84","Select","Select",""],["","00591544310","PREDNISONE ","20MG","21","Select","Select",""],["","49483060450","IBUPROFEN ","800MG","20","Select","Select",""],["","33332032001","AFLURIA ","2020-21","0","Select","Select",""],["","65162052110","PROMETHAZINE ","25MG","10","Select","Select",""],["","64980030550","DENTA ","PLUS","153","Select","Select",""],["","00126028666","PREVIDENT ","5000 PLS","153","Select","Select",""],["","67877054360","CEFDINIR","300MG","10","Select","Select",""],["","67877054360","CEFDINIR ","CAP 300MG","10","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":""}]}]}