{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ABRIEL   S BLACKWELL","gend":1,"add":"1239 OILWELL ROAD","city":"BLACKSBURG","state":"VA","zip":"24060-9998","dob":"2002-04-20","age":"","mstatus":"","insh":"1807693*01","cliId":"","pno":"540\/200-8860","cno":"540\/200-8860","email":"","ename":"","eno":"","pphy":"BERRY, DAVID E DO","ppno":"540\/443-7180","pcpadd":"3700 S MAIN ST SUITE 1A","pcpcity":"BLACKSBURG","pcpstate":"VA","pcpzip":24060,"pcpcounty":"","pcpid":136142,"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":["F41.9","F33.0","J06.9","Z01.419","I95.9"],"date":["2020-07-15","2020-07-15","2020-10-22","2020-06-29","2020-07-21"],"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":[["","00832063111","CLOMIPRAMINE ","50MG","60","Select","Select",""],["","10702001110","HYDROXYZ ","25MG","30","Select","Select",""],["","63868098309","QC ","200MG","240","Select","Select",""],["","38779029803","HYDROXYZINE ","HCL","30","Select","Select",""],["","67877031905","IBUPROFEN ","400MG","20","Select","Select",""],["","59762500801","MISOPROSTOL ","200MCG","1","Select","Select",""],["","10702001110","HYDROXYZ","25MG","30","Select","Select",""],["","00832063111","CLOMIPRAMINE","50MG","60","Select","Select",""],["","63868098309","QC","200MG","240","Select","Select",""],["","38779029803","HYDROXYZINE","HCL","30","Select","Select",""],["","67877031905","IBUPROFEN","400MG","20","Select","Select",""],["","59762500801","MISOPROSTOL","200MCG","1","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":""}]}]}