{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAVANNA   H PRICE","gend":1,"add":"4709 TREE TOP CAMP ROAD","city":"SALEM","state":"VA","zip":"24153-9998","dob":"2003-03-05","age":"","mstatus":"","insh":"1540150*01","cliId":"","pno":"540\/793-4943","cno":"540\/793-4943","email":"","ename":"","eno":"","pphy":"NELSON, KELLY K MD","ppno":"540\/344-9213","pcpadd":"21 HIGHLAND AVE SE","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":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.0","Z20.828","R39.9","N89.8","B86.","Z00.129","J02.9","N39.0","R30.0","F41.8","Z79.3","L70.0","R10.30","K08.89","R68.84","R11.0","N30.00","Z20.822","R35.0","R30.9","Z87.440","R10.2"],"date":["2020-07-02","2020-10-28","2021-06-24","2021-08-19","2020-05-07","2020-10-08","2020-10-28","2021-08-10","2021-05-03","2020-04-06","2020-04-06","2020-02-03","2021-08-19","2021-08-10","2021-08-10","2021-08-10","2021-09-22","2021-08-31","2021-09-22","2021-09-22","2021-10-11","2021-10-11"],"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":[["","00054418425","DEXAMETHASON ","4MG","2","Select","Select",""],["","70700011985","ESTARYLLA ","0.25-35","28","Select","Select",""],["","60432060416","PROMETHAZINE ","DM","120","Select","Select",""],["","00363006160","WAL-PHED ","120MG","20","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","8","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","1","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","28","Select","Select",""],["","65862077685","MILI ","0.25\/35","84","Select","Select",""],["","45802026937","PERMETHRIN ","5%","60","Select","Select",""],["","00168020360","CLINDAMYCIN ","1%","60","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","14","Select","Select",""],["","04142000024","FLORASTOR ","250MG","20","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","14","Select","Select",""],["","65862017760","CEFDINIR ","300MG","14","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","70700011985","ESTARYLLA","0.25-35","28","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","2","Select","Select",""],["","60432060416","PROMETHAZINE","DM","120","Select","Select",""],["","00363006160","WAL-PHED","120MG","20","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","8","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","28","Select","Select",""],["","65862077685","MILI","0.25\/35","84","Select","Select",""],["","45802026937","PERMETHRIN","5%","60","Select","Select",""],["","00168020360","CLINDAMYCIN","1%","60","Select","Select",""],["","65862017760","CEFDINIR","300MG","14","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","00185012201","NITROFURANTN","100MG","14","Select","Select",""],["","04142000024","FLORASTOR","250MG","20","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","14","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":""}]}]}