{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TEPANGA   V MCDANIEL","gend":1,"add":"1110 PECHIN AVE SE","city":"ROANOKE","state":"VA","zip":"24013-9998","dob":"2003-05-10","age":"","mstatus":"","insh":"1539246*01","cliId":"","pno":"540\/598-9506","cno":"540\/598-9506","email":"","ename":"","eno":"","pphy":"BRECH, KILIAN H MD","ppno":"540\/344-9213","pcpadd":"21 HIGHLAND AVE STE 100","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24013,"pcpcounty":"","pcpid":106125,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/855-9178","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N73.9","R10.84","R50.9","R11.10","N76.0","R79.82","A54.9","D72.829","R10.30","B96.89","R11.2","A54.24","A54.03","A54.02","Z20.828","R10.9"],"date":["2020-06-10","2020-06-10","2020-06-10","2020-06-10","2020-06-10","2020-06-10","2020-06-10","2020-06-10","2020-06-10","2020-06-10","2020-06-10","2020-06-09","2020-06-09","2020-06-09","2020-06-09","2020-06-09"],"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":[["","00781808931","AZITHROMYCIN ","250MG","7","Select","Select",""],["","00143980305","DOXYCYCL ","100MG","28","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","28","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","13","Select","Select",""],["","00143980305","DOXYCYCL","100MG","28","Select","Select",""],["","00781808931","AZITHROMYCIN","250MG","7","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":""}]}]}