{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NGOC   KHOA NGOC TRAN","gend":0,"add":"840 VINES ST","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"1967-04-29","age":"","mstatus":"","insh":"1943039*02","cliId":"","pno":"540\/746-0565","cno":"540\/746-0565","email":"","ename":"","eno":"","pphy":"HERNANDEZ, MARIA A MD","ppno":"540\/442-6144","pcpadd":"STE E 129 UNIVERSITY BLVD","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":169185,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"540\/746-0565","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":["I10.","E78.5","Z12.5","Z00.00","R74.01","R94.31","Z86.73","Z60.9","Z12.11","E11.9"],"date":["2021-03-09","2021-03-09","2021-03-09","2020-11-23","2020-12-02","2020-11-23","2020-11-23","2020-11-23","2020-10-13","2021-03-09"],"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":[["","11534016503","FOLIC","1MG","30","Select","Select",""],["","68645055354","LISINOPRIL","20MG","30","Select","Select",""],["","68645059090","CLOPIDOGREL","75MG","30","Select","Select",""],["","68645049554","ATORVASTATIN","80MG","30","Select","Select",""],["","65862014305","CARVEDILOL","6.25MG","-60","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","65862050220","AMOX\/K","500-125","21","Select","Select",""],["","49281072010","FLUBLOK","2020-21","0","Select","Select",""],["","11534016503","FOLIC ","1MG","30","Select","Select",""],["","65862014305","CARVEDILOL ","6.25MG","60","Select","Select",""],["","68645059090","CLOPIDOGREL ","75MG","30","Select","Select",""],["","68645049554","ATORVASTATIN ","80MG","-30","Select","Select",""],["","68645055354","LISINOPRIL ","20MG","-30","Select","Select",""],["","65862050220","AMOX\/K ","500-125","21","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0","Select","Select",""],["","00781261305","AMOXICILLIN ","500MG","21","Select","Select",""],["","00781261305","AMOXICILLIN","500MG","21","Select","Select",""],["","49281042150","FLUZONE ","INJ 2021-22","0","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}