{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEXUS   N PECK","gend":1,"add":"71 EAST TWIN CIRCLE DR APT 4","city":"LEBANON","state":"VA","zip":"24266-9998","dob":"2003-09-26","age":"","mstatus":"","insh":"1739414*01","cliId":"","pno":"276\/596-3218","cno":"276\/596-3218","email":"","ename":"","eno":"","pphy":"EASTON, BRIAN THOMAS MD","ppno":"276\/889-3700","pcpadd":"495 EAST MAIN ST","pcpcity":"LEBANON","pcpstate":"VA","pcpzip":24266,"pcpcounty":"","pcpid":123215,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/889-5505","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["V58.89","M25.561","Z03.818","L25.9","B34.9","R09.81","R05.","Z20.822","R07.89","L30.9","J06.9","F41.0","Z87.09","K21.9","F41.9","F41.8","J02.9","B37.3","X50.1XXA","Z23.","J32.9","B96.89"],"date":["2020-07-22","2020-07-22","2021-01-09","2021-09-10","2021-05-22","2021-05-22","2021-05-22","2021-05-22","2020-05-27","2021-08-11","2020-02-04","2020-03-21","2020-03-21","2020-03-21","2020-03-21","2020-03-21","2020-11-03","2021-06-21","2020-06-13","2021-08-11","2021-09-08","2021-09-08"],"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":[["","00168014630","HYDROCORT ","2.50%","28","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00185067401","HYDROXYZ ","25MG","20","Select","Select",""],["","68462029817","CLOTRIM\/BETA ","DIPROP","45","Select","Select",""],["","45802005911","NYSTATIN ","100000","60","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00185067401","HYDROXYZ","25MG","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","45802005911","NYSTATIN","100000","60","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","68462029817","CLOTRIM\/BETA","DIPROP","45","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","00168014630","HYDROCORT","2.50%","28","Select","Select",""],["","00054001925","PREDNISONE","50MG","5","Select","Select",""],["","50111078751","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","5","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":""}]}]}