{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTANY   C SEAGRAVES","gend":1,"add":"909 FERRIER CT","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1994-07-29","age":"","mstatus":"","insh":"2241446*01","cliId":"","pno":"757\/938-0986","cno":"757\/938-0986","email":"","ename":"","eno":"","pphy":"ULLMAN, CHRISTINE DO","ppno":"540\/674-8805","pcpadd":"118 BROAD ST","pcpcity":"DUBLIN","pcpstate":"VA","pcpzip":24084,"pcpcounty":"","pcpid":147705,"pcpname":"Carilion Clinic Family Medicine Dublin","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/674-8670","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D69.3","R71.8","N93.8","Z87.891","N93.9","Z21.","Z30.46","R09.02","E66.01","Z68.34","R23.3","R23.8","Z00.00","N91.2","E55.9","E66.9","F12.10","N39.0","D69.6","B27.90","F12.90","R05.","M25.50","Z86.2","S40.021A","Z23."],"date":["2021-01-29","2020-06-12","2020-08-18","2020-12-07","2020-08-18","2021-06-10","2020-05-22","2020-05-28","2020-05-29","2020-06-08","2020-06-08","2020-06-08","2020-05-26","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-12-08","2020-06-08","2020-05-29","2020-05-28","2020-05-28","2020-08-18","2020-12-07","2021-06-10"],"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":[["","00054418425","DEXAMETHASON","4MG","30","Select","Select",""],["","61958250101","BIKTARVY","","30","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","10","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","-4","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","40","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","10","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","-4","Select","Select",""],["","61958250101","BIKTARVY ","","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":""}]}]}