{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LESLIE DARNELL","gend":1,"add":"7532 HUNTERS VALLEY ROAD E","city":"DUNGANNON","state":"VA","zip":"24245-9998","dob":"2001-12-17","pno":"276\/995-1154","cno":"276\/995-1154","email":"","pphy":"CASSEL, TODD A MD","ppno":"","pcpadd":"17285 VETERANS MEMORIAL HWY","pcpcity":"DUNGANNON","pcpstate":"VA","pcpzip":24245,"pcpcounty":"","pcpid":110741,"pcpname":"","insh":"1576831*01","cliId":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"276\/356-1614","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/467-2673","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H10.45","G43.C0","U07.1","J06.9","J02.9","R50.9","Z20.822","J18.9","R07.89","E66.9","Z86.16","Z68.37","J01.90","R05.","R07.9","Z03.818","J01.00","J22.","N39.0","R31.9","N92.6"],"date":["2020-08-05","2020-08-05","2021-08-28","2020-01-06","2021-08-19","2020-01-06","2021-09-01","2021-03-21","2021-09-02","2021-09-02","2021-09-02","2021-09-02","2021-06-10","2021-06-10","2021-09-01","2021-08-19","2021-09-16","2020-01-11","2021-01-09","2021-01-09","2021-01-09"],"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":[["","64380071206","BENZONATATE ","CAP 100MG","20","Select","Select",""],["","24658031205","DOXYCYCL ","TAB 100MG","14","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL ","AER HFA","8","Select","Select",""],["","59746000103","METHYLPRED ","TAB 4MG","21","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","21","Select","Select",""],["","00172541211","FLUCONAZOLE ","TAB 150MG","2","Select","Select",""],["","00781604146","AMOXICILLIN ","SUS 250\/5ML","200","Select","Select",""],["","00143973801","PREDNISONE ","TAB 20MG","10","Select","Select",""],["","49502010202","EPINEPHRINE ","INJ 0.3MG","2","Select","Select",""],["","00054418625","DEXAMETHASON ","TAB 6MG","14","Select","Select",""],["","49502050002","EPIPEN ","INJ 0.3MG","2","Select","Select",""],["","00781618667","CIPRO\/DEXA ","SUS 0.3-0.1%","8","Select","Select",""],["","69238161503","OFLOXACIN ","DRO 0.3%OTIC","5","Select","Select",""],["","00234057504","HIBICLENS ","LIQ 0.04","118","Select","Select",""],["","66689000802","NYSTATIN ","SUS 100000","60","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","7","Select","Select",""],["","00310737220","BUDES\/FORMOT ","AER 80-4.5","10","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":""}]}]}