{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REGINA   N BENNETT","gend":1,"add":"146 FRANCES ROAD","city":"JAVA","state":"VA","zip":"24565-9998","dob":"1987-01-15","age":"","mstatus":"","insh":"1604890*01","cliId":"","pno":"434\/432-0590","cno":"434\/432-0590","email":"","ename":"","eno":"","pphy":"HEALTH DEPT, PITTSYLVANIA MD","ppno":"434\/432-7232","pcpadd":"200 H G MCGHEE DR","pcpcity":"CHATHAM","pcpstate":"VA","pcpzip":24531,"pcpcounty":"","pcpid":104417,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/483-7620","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":["L03.113","M79.641","M65.9","G47.00","E11.9","G62.9","I73.9","F41.9","E55.9","E66.9"],"date":["2020-12-09","2020-12-09","2020-12-22","2020-06-09","2020-06-09","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":[["","00310621030","FARXIGA ","10MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","68382075810","METFORMIN ","500MG","42","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","65162019050","NAPROXEN ","500MG","20","Select","Select",""],["","00603533815","PREDNISONE ","10MG","21","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","20","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","00310621030","FARXIGA","10MG","30","Select","Select",""],["","68382075810","METFORMIN","500MG","42","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","20","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","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":""}]}]}