{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ONDREA SMITH","gend":1,"add":"2025 ROSE LN","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1992-08-01","age":"","mstatus":"","insh":"1506541*01","cliId":"","pno":"434\/200-0635","cno":"434\/200-0635","email":"","ename":"","eno":"","pphy":"JOHNSON, MATTHEW MD","ppno":"434\/200-3366","pcpadd":"1900 TATE SPRINGS ROAD SUITE 3","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24501,"pcpcounty":"","pcpid":190030,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H20.9","H16.9","Z95.818","Z30.09","N92.1","H16.8","H11.813","I63.9","Z79.899","D50.9","Z11.3","L66.9","Z30.40","H15.043","Z01.419","H05.10","Z30.017","Z30.46","H18.713","H17.823","NO DATA","H53.10","H15.049","H52.213","H16.403","Z60.9","Z78.9","Z97.3","S16.1XXA","D64.9","V89.2XXA","Y92.410"],"date":["2020-09-09","2021-04-28","2020-11-25","2021-09-14","2021-04-15","2021-06-01","2021-08-25","2020-10-07","2021-07-07","2021-01-27","2021-01-22","2021-03-10","2021-03-25","2021-08-25","2020-08-13","2020-08-13","2021-02-15","2021-02-15","2020-08-12","2021-07-07","2020-08-12","2020-08-12","2020-11-25","2021-03-01","2021-08-25","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07"],"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":[["","52565002559","FLUOCINONIDE ","0.05%","60","Select","Select",""],["","00074153903","HUMIRA ","PS\/UV","3","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","4","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","10","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","61314063705","PREDNISOLONE","1% OP","10","Select","Select",""],["","52565002559","FLUOCINONIDE","0.05%","60","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","4","Select","Select",""],["","00074055402","HUMIRA","40\/0.4ML","2","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","33332032101","AFLURIA","2021-22","0","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":""}]}]}