{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LENA   N WATTS","gend":1,"add":"1701 SPRINGHILL RD APT E24","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1984-04-28","age":"","mstatus":"","insh":"1238920*01","cliId":"","pno":"540\/466-5274","cno":"540\/466-5274","email":"","ename":"","eno":"","pphy":"JOHNSON, FRANK MD","ppno":"540\/886-6259","pcpadd":"STE 511 42 LAMBERT ST","pcpcity":"STAUNTON","pcpstate":"VA","pcpzip":24401,"pcpcounty":"","pcpid":190956,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"540\/466-0673","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/885-1696","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","R80.9","E78.2","R63.4","M25.50","M79.2","F41.8","N10.","R10.13","G40.89","S09.90XA","M79.605","E11.9","Z79.4","K29.70","R56.9"],"date":["2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2020-07-28","2020-12-26","2020-10-27","2020-10-27","2020-10-27","2020-02-10","2020-02-10","2020-12-26","2020-10-27"],"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":[["","00002751001","HUMALOG ","100\/ML","10","Select","Select",""],["","68180071160","CEFDINIR ","300MG","20","Select","Select",""],["","27241009803","DULOXETINE ","30MG","120","Select","Select",""],["","00093762498","PREGABALIN ","75MG","60","Select","Select",""],["","66733077301","INSULIN ","100\/ML","10","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","15","Select","Select",""],["","27808003502","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","00169643810","LEVEMIR ","FLEXTOUC","15","Select","Select",""],["","68180011302","LEVETIRACETA ","500MG","60","Select","Select",""],["","08290320550","BD  PEN NEEDL","32GX5\/32","100","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00002751001","HUMALOG","100\/ML","10","Select","Select",""],["","00093762498","PREGABALIN","75MG","60","Select","Select",""],["","66733077301","INSULIN","100\/ML","10","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","15","Select","Select",""],["","27808003502","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","68180071160","CEFDINIR","300MG","20","Select","Select",""],["","08290320550","BD PEN NEEDL","32GX5\/32","100","Select","Select",""],["","27241009803","DULOXETINE","30MG","120","Select","Select",""],["","68180011302","LEVETIRACETA","500MG","60","Select","Select",""],["","00169643810","LEVEMIR","FLEXTOUC","15","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","30","Select","Select",""],["","53885027210","ONETOUCH ","TES VERIO","100","Select","Select",""],["","00002143380","TRULICITY ","INJ 0.75\/0.5","2","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}