{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBECCA MORRIS","gend":1,"add":"1769 PETREE DR","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1993-03-22","age":"","mstatus":"","insh":"2352377*01","cliId":"","pno":"609\/618-8750","cno":"609\/618-8750","email":"","ename":"","eno":"","pphy":"LEPAGE, JOSEPH T MD","ppno":"757\/721-0512","pcpadd":"HPT RDS-CONTRACT REP 5000 COX RD ST","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":125384,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"609\/618-8750","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/968-4243","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N94.10","N95.1","E06.3","E31.9","D50.8","Z79.891","E03.9","I25.10","N39.0","K51.20","K51.90","Z12.4","Z01.411","Z30.02","N94.12","M79.674","M20.41","R10.2","Z02.0","Z23.","Z11.1","Z01.84","Z02.1","J01.90"],"date":["2021-01-28","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-01-14","2021-02-25","2021-02-25","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-22","2021-01-22","2021-01-28","2021-07-20","2021-07-17","2021-07-17","2021-07-17","2021-07-08","2021-08-24"],"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":[["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","70710130207","MESALAMINE","1000MG","30","Select","Select",""],["","16714083001","MESALAMINE ","1.2GM","180","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","63304061650","DOXYCYC ","100MG","20","Select","Select",""],["","63304061650","DOXYCYC","100MG","20","Select","Select",""],["","33332032101","AFLURIA","2021-22","0","Select","Select",""],["","33332032101","AFLURIA ","INJ 2021-22","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","",""],["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":""}]}]}