{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHELLA LEIGH","gend":1,"add":"2002 SMALLEYS DAM CIR","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1963-10-15","age":"","mstatus":"","insh":"1971161*01","cliId":"","pno":"757\/635-7978","cno":"757\/635-7978","email":"","ename":"","eno":"","pphy":"MANDELL JR, M STEPHEN MD","ppno":"804\/633-5840","pcpadd":"121 COURTHOUSE LN","pcpcity":"BOWLING GREEN","pcpstate":"VA","pcpzip":22427,"pcpcounty":"","pcpid":195552,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"757\/635-7978","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/633-4438","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.562","M25.462","J01.00","J30.2","J30.9","L64.9","Z12.11"],"date":["2021-03-30","2021-03-30","2021-04-01","2021-04-01","2021-04-01","2021-08-20","2021-05-23"],"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":[["","57237002801","AMOXICILLIN ","500MG","30","Select","Select",""],["","57237006130","FINASTERIDE ","1MG","30","Select","Select",""],["","51660093901","CETIRIZINE ","10MG","30","Select","Select",""],["","59746017506","PREDNISONE ","20MG","13","Select","Select",""],["","65162027210","SMZ\/TMP ","800-160","20","Select","Select",""],["","65162011510","HYDROCO\/APAP ","7.5-325","8","Select","Select",""],["","68382005101","MELOXICAM ","15MG","40","Select","Select",""],["","11822505390","RA ","10MG","30","Select","Select",""],["","65162027210","SMZ\/TMP","800-160","20","Select","Select",""],["","59746017506","PREDNISONE","20MG","13","Select","Select",""],["","51660093901","CETIRIZINE","10MG","30","Select","Select",""],["","65162011510","HYDROCO\/APAP","7.5-325","8","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","30","Select","Select",""],["","68382005101","MELOXICAM","15MG","40","Select","Select",""],["","11822505390","RA","10MG","30","Select","Select",""],["","57237006130","FINASTERIDE","1MG","30","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":""}]}]}