{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHELSEA   R AARON","gend":1,"add":"PO BOX 47","city":"LANEXA","state":"VA","zip":"23089-9998","dob":"1996-09-20","age":"","mstatus":"","insh":"1198091*01","cliId":"","pno":"804\/833-0637","cno":"804\/833-0637","email":"","ename":"","eno":"","pphy":"ALLEGA, GIULIANA MD","ppno":"434\/315-2850","pcpadd":"935 SOUTH MAIN STREET","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":23901,"pcpcounty":"","pcpid":135922,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["V91.03","O99.512","Z3A.21","O31.22X1","O23.592","Z3A.25","P95.","O31.23X0","Z3A.28","I47.1","I95.9","R94.31","Z20.828","Z37.1","M54.5","O30.009","O36.4XX1","Z3A.33","O60.14X2","Z37.0","R79.89","E87.2","Z39.1","Z3A.30","Z39.2","H66.93","O47.03","Z37.3","I07.1","O99.42","O99.344","E66.9","F41.9","O99.284","J45.909","O99.52","O99.214","O99.89","Z3A.24","I36.1","I34.0","M25.512","S46.002A"],"date":["2020-09-16","2020-06-19","2020-06-19","2020-07-17","2020-07-17","2020-07-17","2020-07-17","2020-08-26","2020-08-13","2020-09-18","2020-09-18","2020-09-17","2020-12-06","2020-09-16","2020-07-15","2020-06-19","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-18","2020-09-18","2020-09-30","2020-08-26","2020-09-18","2020-08-29","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-09-16","2020-07-15","2020-07-15","2020-09-17","2020-09-17","2020-12-01","2020-12-01"],"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":[["","68645056354","IBUPROFEN ","800MG","60","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","30","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","16714061205","SERTRALINE ","50MG","90","Select","Select",""],["","00517072001","BETA-PHOS\/AC ","3-3MG\/ML","5","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","10","Select","Select",""],["","00168034646","TERCONAZOLE ","0.40%","45","Select","Select",""],["","65862050320","AMOX\/K ","875-125","14","Select","Select",""],["","57237002901","AMOXICILLIN ","875MG","20","Select","Select",""],["","31722053301","METHOCARBAM ","500MG","40","Select","Select",""],["","00065853110","CIPRO ","OTIC","10","Select","Select",""],["","43598032675","CIPRO\/DEXA ","0.3-0.1%","8","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","30","Select","Select",""],["","00517072001","BETA-PHOS\/AC","3-3MG\/ML","5","Select","Select",""],["","16714061205","SERTRALINE","50MG","90","Select","Select",""],["","57237002901","AMOXICILLIN","875MG","20","Select","Select",""],["","68645056354","IBUPROFEN","800MG","60","Select","Select",""],["","51672130406","TERCONAZOLE","0.40%","45","Select","Select",""],["","76385012350","METHOCARBAM","500MG","40","Select","Select",""],["","43598032675","CIPRO\/DEXA","0.3-0.1%","8","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","00065853110","CIPRO","OTIC","10","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","10","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","",""],["Yes","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":""}]}]}