{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTIN   SIGNE SCHRIMPER","gend":1,"add":"5900 STAGE JUNCTION ROAD","city":"COLUMBIA","state":"VA","zip":"23038-9998","dob":"1966-01-10","age":"","mstatus":"","insh":"1770356*01","cliId":"","pno":"703\/615-4443","cno":"703\/615-4443","email":"","ename":"","eno":"","pphy":"LANFORD, RANDOLPH E MD","ppno":"434\/842-3244","pcpadd":"4064 JAMES MADISON HIGHWAY","pcpcity":"FORK UNION","pcpstate":"VA","pcpzip":23055,"pcpcounty":"","pcpid":105418,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"CENTRAL","aligned":"","ano":"434\/589-2587","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":["S89.90XA","K57.30","S89.91XA","W22.8XXA","Y93.9","Y92.9","Z00.01","I10.","H01.9","Z12.39","R58.","N95.1","F41.9","Z01.419","B00.9","F32.4","Z12.11","R32.","Z20.828","Z23.","Z11.3","M25.571","M79.661","M79.604","S80.11XA"],"date":["2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-13","2021-05-23","2021-05-13","2020-07-30","2021-05-13","2020-01-21","2021-06-07","2021-06-07","2021-07-14","2021-07-14"],"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":[["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","65862046890","LOSARTAN\/HCT","50-12.5","30","Select","Select",""],["","68382009805","PAROXETINE","20MG","30","Select","Select",""],["","00378427577","VALACYCLOVIR","500MG","36","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00168005615","BETAMETH","0.05%","15","Select","Select",""],["","00555097302","AMPHET\/DEXTR","20MG","240","Select","Select",""],["","00591024001","LORAZEPAM","0.5MG","30","Select","Select",""],["","0","","","15","Select","Select",""],["","51672139500","TRETINOIN","0.10%","20","Select","Select",""],["","00574402435","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","65862046890","LOSARTAN\/HCT ","50-12.5","30","Select","Select",""],["","00555097302","AMPHET\/DEXTR ","20MG","240","Select","Select",""],["","00378427577","VALACYCLOVIR ","500MG","36","Select","Select",""],["","00591024001","LORAZEPAM ","0.5MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00168005615","BETAMETH ","0.05%","15","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","68382009805","PAROXETINE ","20MG","30","Select","Select",""],["","51672139500","TRETINOIN ","0.10%","20","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","60","Select","Select",""],["","65162010250","GABAPENTIN","300MG","60","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":""}]}]}