{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ZOE  E MADDEN","gend":1,"add":"921 CHADWICK CT APT A","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"2002-05-09","age":"","mstatus":"","insh":"1237963*01","cliId":"","pno":"540\/836-5077","cno":"540\/836-5077","email":"","ename":"","eno":"","pphy":"FISHER, JOSEPH D MD","ppno":"540\/932-0980","pcpadd":"57 BEAM LANE SUITE 202","pcpcity":"FISHERSVILLE","pcpstate":"VA","pcpzip":22939,"pcpcounty":"","pcpid":100684,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","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":["F33.1","F33.2","V62.84","Z72.89","F33.0","F90.0","F50.9","Z62.810","M25.562","E66.01","Z68.53","J20.9","F31.32","Z30.09","Z68.45","G44.229"],"date":["2020-03-06","2020-07-22","2020-02-08","2020-02-07","2020-05-12","2020-05-14","2020-02-08","2020-02-08","2020-02-26","2020-07-09","2020-02-08","2020-03-13","2020-04-08","2020-07-09","2020-07-09","2020-02-20"],"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":[["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","65862001330","SERTRALINE ","100MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM ","10MG","30","Select","Select",""],["","54092039101","ADDERALL ","30MG","30","Select","Select",""],["","51672413001","LAMOTRIGINE ","25MG","30","Select","Select",""],["","11822880980","RA ","3MG","15","Select","Select",""],["","60505392701","GUANFACINE ","1MG ER","30","Select","Select",""],["","00228306111","AMPHET\/DEXTR ","30MG ER","30","Select","Select",""],["","16714040803","LARIN ","Jan-20","21","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","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","",""],["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":""}]}]}