{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARLES   E WEBB","gend":0,"add":"3861 COUNTRY CLUB ROAD","city":"TROUTVILLE","state":"VA","zip":"24175-9998","dob":"1999-09-14","age":"","mstatus":"","insh":"2090557*03","cliId":"","pno":"540\/293-8714","cno":"540\/293-8714","email":"","ename":"","eno":"","pphy":"PHYSICIAN, PRIMARY CARE (MISC)","ppno":"","pcpadd":"4417 CORPORATION LN","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":799999,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"ROANOKE ALLEGHANY","aligned":"","ano":"540\/293-8714","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":["S06.0X0D","F41.1","F90.0","F32.9","Z86.59","F33.2","Z79.899","F41.9","J02.9","R41.841","R41.840","F07.81","M25.511","M25.572","L91.8","G89.29","B27.90","H60.501"],"date":["2020-02-13","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-10-21","2020-10-21","2020-03-04","2021-07-01","2020-01-02","2020-01-02","2020-01-02","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-07-01","2021-07-01"],"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":[["","49502050002","EPIPEN","0.3MG","2","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","59417010210","VYVANSE","20MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","20","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00093117410","PENICILLN","500MG","30","Select","Select",""],["","00115169449","EPINEPHRINE","0.3MG","2","Select","Select",""],["","24208063562","NEO\/POLY\/HC","1% OTIC","20","Select","Select",""],["","00378064205","PREDNISONE","20MG","10","Select","Select",""],["","00173068220","VENTOLIN ","","-18","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","49502050002","EPIPEN ","0.3MG","2","Select","Select",""],["","00115169449","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","20","Select","Select",""],["","24208063562","NEO\/POLY\/HC ","1% OTIC","20","Select","Select",""],["","59417010210","VYVANSE ","20MG","30","Select","Select",""],["","00378064205","PREDNISONE ","20MG","10","Select","Select",""],["","00093117410","PENICILLN ","500MG","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":""}]}]}