{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ISAAC HULL","gend":0,"add":"321 SUNRISE AVE","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"1976-04-17","age":"","mstatus":"","insh":"2001954*01","cliId":"","pno":"540\/435-0047","cno":"540\/435-0047, ","email":"","ename":"","eno":"","pphy":"LEPLEY, SHAWN M MD","ppno":"540\/564-7300","pcpadd":"1661 S MAIN ST","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":"22801-9998","pcpcounty":"","pcpid":188285,"pcpname":"SRMHMG - Sentara South Main Health Center","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","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":["J30.9","Z76.0","M25.571","M25.572","E03.9","L40.9","M79.671","M79.672","L40.50","M25.50","S61.451A","R20.2","Z88.5","L40.0","G62.9","Z23."],"date":["2020-01-20","2021-01-13","2021-01-13","2021-01-13","2021-04-02","2020-10-09","2020-08-06","2020-08-06","2021-05-13","2021-05-07","2020-05-21","2020-05-21","2020-05-21","2021-05-13","2020-10-02","2020-11-24"],"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":[["","31722063231","OSELTAMIVIR","75MG","10","Select","Select",""],["","00002144511","TALTZ","80MG\/ML","1","Select","Select",""],["","00527328043","LEVOTHYROXIN","25MCG","-30","Select","Select",""],["","68382005105","MELOXICAM","15MG","30","Select","Select",""],["","16714047802","AMOX\/K","875-125","20","Select","Select",""],["","72305002530","EUTHYROX","25MCG","-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","",""],["No","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":""}]}]}