{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENICE   N CRUMP","gend":1,"add":"151 GOSHEN ROAD","city":"CUMBERLAND","state":"VA","zip":"23040-9998","dob":"2002-02-16","age":"","mstatus":"","insh":"1041395*01","cliId":"","pno":"804\/492-3102","cno":"804\/492-3102","email":"","ename":"","eno":"","pphy":"DODD, JEFFREY MD","ppno":"804\/897-2159","pcpadd":"2891 ANDERSON HWY","pcpcity":"POWHATAN","pcpstate":"VA","pcpzip":23139,"pcpcounty":"","pcpid":179869,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/250-5774","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","Z20.828","M54.5","M25.551","J20.9","N92.6","Z32.02","S63.501A","S43.402A","W19.XXXA","Y92.89","Y93.89","L03.211","M54.17","J03.90","N39.44","J30.2","Z20.2","U07.1","J35.1","J45.909","Z88.0","Z82.49","R05.","J01.00","J45.40","N90.7","L73.1","Z30.09","Z30.46"],"date":["2021-04-02","2020-06-26","2021-07-15","2020-07-23","2020-03-26","2020-10-28","2020-08-27","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-04-01","2020-08-20","2021-02-11","2020-06-05","2020-06-05","2020-07-07","2021-01-08","2021-02-11","2020-03-20","2020-03-20","2020-03-20","2020-03-20","2020-03-26","2020-03-26","2021-03-01","2021-03-01","2021-04-19","2021-04-19"],"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":[["","00527150237","AMPHET\/DEXTR ","10MG","60","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","69238126601","OSELTAMIVIR ","75MG","10","Select","Select",""],["","50242086002","XOFLUZA ","40MG","2","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00054001925","PREDNISONE ","50MG","5","Select","Select",""],["","68180071160","CEFDINIR ","300MG","20","Select","Select",""],["","60505025801","DESMOPRESSIN ","0.2MG","30","Select","Select",""],["","67877022005","CEPHALEXIN ","250MG","40","Select","Select",""],["","71093014005","METHOCARBAM ","500MG","20","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00046110281","PREMARIN ","0.625MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR ","1GM","20","Select","Select",""],["","00093767902","ETONOGESTREL ","ETHY EST","3","Select","Select",""],["","80777027398","MODERNA ","COVID-19","0","Select","Select",""],["","00527150237","AMPHET\/DEXTR","10MG","60","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","69238126601","OSELTAMIVIR","75MG","10","Select","Select",""],["","50242086002","XOFLUZA","40MG","2","Select","Select",""],["","00054001925","PREDNISONE","50MG","5","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","68180071160","CEFDINIR","300MG","20","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","60505025801","DESMOPRESSIN","0.2MG","30","Select","Select",""],["","71093014005","METHOCARBAM","500MG","20","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00046110281","PREMARIN","0.625MG","30","Select","Select",""],["","67877022005","CEPHALEXIN","250MG","40","Select","Select",""],["","00093767902","ETONOGESTREL","ETHY EST","3","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","31722070530","VALACYCLOVIR","1GM","20","Select","Select",""],["","65162019050","NAPROXEN ","TAB 500MG","60","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}