{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIAH MORRIS","gend":1,"add":"1118 NEWS FERRY TRL","city":"SOUTH BOSTON","state":"VA","zip":"24592-9998","dob":"2002-09-28","age":"","mstatus":"","insh":"1182284*01","cliId":"","pno":"434\/446-3970","cno":"434\/446-3970","email":"","ename":"","eno":"","pphy":"EBALO, NONNA L MD","ppno":"434\/572-3635","pcpadd":"2202 BEECHMONT ROAD","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":172632,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"000\/000-0000","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.21","J30.9","J01.00","F32.2","A59.9","F90.9","J02.9","F43.21","F33.2","Z00.01","F34.1","J45.31","N94.6"],"date":["2020-12-30","2021-03-04","2020-01-14","2020-08-14","2020-07-17","2020-11-17","2020-12-30","2021-01-19","2020-12-29","2021-03-04","2021-03-04","2021-03-04","2021-06-11"],"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":[["","00378064110","PREDNISONE ","10MG","20","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","69097083512","SERTRALINE ","100MG","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","31604002743","MELATONIN ","5MG","30","Select","Select",""],["","47469007064","","","30","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","13668013601","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","59779045888","ALLERGY ","10MG","30","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","00093031401","KETOROLAC ","10MG","20","Select","Select",""],["","68180016013","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00456074613","AERCHMBR ","LRG MASK","1","Select","Select",""],["","69097083512","SERTRALINE","100MG","30","Select","Select",""],["","00378064110","PREDNISONE","10MG","20","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","68180016013","AZITHROMYCIN","250MG","6","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00456074613","AERCHMBR","LRG MASK","1","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","50428027684","MELATONIN","5MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","59779045888","ALLERGY","10MG","30","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","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":""}]}]}