{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA EHLE","gend":1,"add":"94 BERKELEY AVE","city":"GROTTOES","state":"VA","zip":"24441-9998","dob":"1964-09-01","age":"","mstatus":"","insh":"2001312*01","cliId":"","pno":"540\/246-2042","cno":"540\/246-2042","email":"","ename":"","eno":"","pphy":"DUTCHER, TITUS L MD","ppno":"540\/234-9241","pcpadd":"1151 KEEZLETOWN RD SUITE 101","pcpcity":"WEYERS CAVE","pcpstate":"VA","pcpzip":24486,"pcpcounty":"","pcpid":147705,"pcpname":"Radford Student Health Center","plan":"OHP","program":"ACA","lob":"Individual","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/234-9200","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K56.609","K86.2","K91.850","Z01.419","K52.9","D49.0","R43.8","Z20.828","Z12.11","K51.919","F32.9","Z20.822","Z12.31"],"date":["2020-08-17","2020-08-17","2020-08-21","2021-03-04","2020-04-03","2020-08-21","2020-12-21","2020-12-21","2021-05-23","2020-05-18","2020-05-18","2021-10-21","2021-11-12"],"priorHcc":["","","","","","","","","","","",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":[["","13668013605","ESCITALOPRAM","10MG","30","Select","Select",""],["","57894006103","STELARA","90MG\/ML","1","Select","Select",""],["","70461042010","FLUCLVX","2020-21","0","Select","Select",""],["","13668013605","ESCITALOPRAM ","10MG","30","Select","Select",""],["","57894006103","STELARA ","90MG\/ML","1","Select","Select",""],["","70461042010","FLUCLVX ","2020-21","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":[[["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":""}]}]}