{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RYAN   J RANDALL","gend":0,"add":"17501 OLD RIDGE RD APT A","city":"MONTPELIER","state":"VA","zip":"23192-9998","dob":"1988-06-20","age":"","mstatus":"","insh":"20033756*01","cliId":"","pno":"804\/360-9728","cno":"804\/360-9728","email":"","ename":"","eno":"","pphy":"STRAZULLO, JOHN MD","ppno":"","pcpadd":"RICH- CONTRACT REP 5000 COX RD STE","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":125392,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/968-4243","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","Z79.899","D22.5","L70.0","Z85.71","H33.103","Z86.69","Z98.890","H44.21","R21.","E21.3","E55.9","G47.10","G47.30","R53.83","E53.8","E04.2","C81.90","D69.6","E80.6","S93.505A","S99.921A","Z13.828","L70.9","Z87.2","J06.9","E89.2","Z90.89","Z85.850","D69.59","R07.9","R63.4","Z94.84","R94.31"],"date":["2020-03-16","2021-08-06","2021-06-07","2020-06-01","2020-06-01","2020-06-17","2020-06-17","2020-06-17","2020-06-17","2020-02-18","2020-12-29","2021-10-21","2020-05-18","2020-05-18","2020-10-08","2021-10-21","2021-10-21","2021-08-06","2020-12-29","2020-12-29","2020-05-19","2020-05-19","2020-05-18","2021-06-07","2021-06-07","2020-01-06","2020-04-28","2020-04-28","2020-04-28","2021-08-06","2021-08-06","2021-08-06","2021-08-06","2021-11-04"],"priorHcc":["","","","","","","","","","","",null,"","","",null,null,"","","","","","","","","","","","","","","","",null]}},{"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":[["","00143962125","CYANOCOBALAM ","1000MCG","2","Select","Select",""],["","59762374301","CLINDAMYCIN ","1%","30","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","00143962125","CYANOCOBALAM","1000MCG","2","Select","Select",""],["","59762374301","CLINDAMYCIN","1%","30","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","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","",""],["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":""}]}]}