{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIE   C COMPTON","gend":1,"add":"1020 MELON ROAD","city":"LONG ISLAND","state":"VA","zip":"24569-9998","dob":"1984-03-14","age":"","mstatus":"","insh":"20025685*01","cliId":"","pno":"434\/349-9970","cno":"434\/349-9970","email":"","ename":"","eno":"","pphy":"BUCKMAN, PAUL S MD","ppno":"434\/349-3113","pcpadd":"15210 L P BAILEY MEMORIAL HIGHWAY","pcpcity":"NATHALIE","pcpstate":"VA","pcpzip":24577,"pcpcounty":"","pcpid":105510,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/349-2172","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B00.9","F43.23","E03.9","E55.9","R53.83","Z11.59","E78.2","H43.813","H52.203","H52.13","R06.00","B37.3","D23.9","L25.9","E78.5","R30.9","G44.52"],"date":["2020-01-24","2021-04-06","2021-05-25","2021-04-06","2021-03-29","2021-03-29","2021-03-29","2021-05-10","2021-05-10","2021-05-10","2021-06-07","2020-02-27","2020-02-27","2021-07-27","2020-02-20","2020-02-20","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":[["","65162080710","PROGESTERONE ","100MG","30","Select","Select",""],["","67405060301","FLUCONAZOLE ","150MG","2","Select","Select",""],["","42806034905","BUPROPN ","300MG XL","30","Select","Select",""],["","00781518710","LEVOTHYROXIN ","150MCG","30","Select","Select",""],["","00378427593","VALACYCLOVIR ","500MG","30","Select","Select",""],["","43547028110","ESCITALOPRAM ","10MG","30","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","30","Select","Select",""],["","00054981729","PREDNISONE ","10MG","24","Select","Select",""],["","42806034905","BUPROPN","300MG XL","30","Select","Select",""],["","00781518710","LEVOTHYROXIN","150MCG","30","Select","Select",""],["","67405060301","FLUCONAZOLE","150MG","2","Select","Select",""],["","00378427593","VALACYCLOVIR","500MG","30","Select","Select",""],["","65162080710","PROGESTERONE","100MG","30","Select","Select",""],["","43547028110","ESCITALOPRAM","10MG","30","Select","Select",""],["","42806031250","DOXYCYCL","100MG","30","Select","Select",""],["","00054981729","PREDNISONE","10MG","24","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","",""],["No","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":""}]}]}