{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" TERESA P CRAMER","gend":1,"add":"101 MILESTONE CT","city":"BRIDGEWATER","state":"VA","zip":"22812-9998","dob":"1968-02-21","age":"","mstatus":"","insh":"2086613*01","cliId":"","pno":"540\/282-7137","cno":"540\/282-7137, ","email":"","ename":"","eno":"","pphy":"MOSS, JONATHAN D MD","ppno":"540\/828-2634","pcpadd":"200 HIGH ST","pcpcity":"BRIDGEWATER","pcpstate":"VA","pcpzip":"22812-9998","pcpcounty":"","pcpid":147705,"pcpname":"Carilion Family Medicine - Bridgewater","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":["Z12.11","K57.30","K64.8","G40.909","Z86.010","Z87.442","Z79.899","Z83.71","Z82.49","Z88.1","R56.9","Z01.419","R92.2","N64.89","Z91.89","Z80.42","N95.1","B34.9","Z20.828","Z00.00","E53.8","Z30.433","Z32.02","M65.341","Z23.","M65.331","Z12.31"],"date":["2020-01-13","2020-01-13","2020-01-13","2020-01-13","2020-01-13","2020-01-13","2021-05-20","2020-01-13","2020-01-13","2020-01-13","2021-05-20","2020-07-17","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-08-03","2020-09-17","2020-09-18","2020-07-14","2021-05-20","2020-10-07","2020-10-07","2020-11-25","2020-10-26","2020-10-26","2020-06-02"],"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":[["","68180011507","LEVETIRACETA","1000MG","120","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","4","Select","Select",""],["","13668001005","CITALOPRAM","20MG","30","Select","Select",""],["","51991029301","OXCARBAZEPIN","300MG","120","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":""}]}]}