{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YANICE JONES","gend":1,"add":"PO BOX 2445","city":"CHESTER","state":"VA","zip":"23831-9998","dob":"1969-03-02","age":"","mstatus":"","insh":"1872210*01","cliId":"","pno":"804\/299-9333","cno":"804\/299-9333","email":"","ename":"","eno":"","pphy":"LINGLER, KIMBERLEY MD","ppno":"","pcpadd":"12801 IRON BRIDGE ROAD SUITE 200","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":23831,"pcpcounty":"","pcpid":208807,"pcpname":"SOUTHSIDE PHYSICIANS NETWORK - FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Individual","region":"CENTRAL","aligned":"","ano":"804\/299-9333","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":["B20.","D64.9","Z11.3","E78.5","Z00.00","N30.01","D50.9"],"date":["2021-09-27","2021-03-30","2021-09-27","2021-09-27","2021-03-30","2021-05-30","2021-09-27"],"priorHcc":[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":[["","61958200201","DESCOVY","200\/25MG","30","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","-30","Select","Select",""],["","49702022813","TIVICAY","50MG","30","Select","Select",""],["","59746000103","METHYLPRED","4MG","-21","Select","Select",""],["","00116200116","CHLORHEX","0.12%","-473","Select","Select",""],["","00185012201","NITROFURANTN","100MG","10","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","49281058905","MENACTRA","","0","Select","Select",""],["","61958200201","DESCOVY ","200\/25MG","30","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","-30","Select","Select",""],["","49702022813","TIVICAY ","50MG","30","Select","Select",""],["","49281058905","MENACTRA ","","0","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","10","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","1","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","-473","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":""}]}]}