{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRYANNA RICCHIUTO","gend":1,"add":"C\/O NANNY CASSIDY 873 GLENDALE AVE","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"2002-11-21","age":"","mstatus":"","insh":"20033928*01","cliId":"","pno":"434\/709-6278","cno":"434\/709-6278","email":"","ename":"","eno":"","pphy":"HEALTH DEPT, DANVILLE CITY MD","ppno":"434\/799-5190","pcpadd":"PRIMARY CARE SERVICES 326 TAYLOR RD","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":112461,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","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":["J06.9","H00.012","B35.4","F90.0","F84.0","J20.9","Z20.828","H57.12","H16.8","N76.0","L03.90"],"date":["2021-03-09","2020-09-15","2020-09-15","2020-02-14","2020-02-14","2021-06-23","2021-06-23","2021-04-06","2021-04-28","2021-05-12","2021-05-12"],"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":[["","54092039101","ADDERALL ","30MG","30","Select","Select",""],["","00228306111","AMPHET\/DEXTR ","30MG ER","30","Select","Select",""],["","51672129801","KETOCONAZOLE ","2%","30","Select","Select",""],["","00574402435","ERYTHROMYCIN ","5MG\/GM","4","Select","Select",""],["","61314062810","POLYMYXIN ","TRIMETHP","10","Select","Select",""],["","00054001925","PREDNISONE ","50MG","6","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","69097014260","ALBUTEROL ","HFA","7","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","40","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","54092039101","ADDERALL","30MG","30","Select","Select",""],["","00228306111","AMPHET\/DEXTR","30MG ER","30","Select","Select",""],["","51672129801","KETOCONAZOLE","2%","30","Select","Select",""],["","00574402435","ERYTHROMYCIN","5MG\/GM","4","Select","Select",""],["","61314062810","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","40","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","00054001925","PREDNISONE","50MG","6","Select","Select",""],["","00085113201","PROVENTIL ","AER HFA","7","Select","Select",""],["","60432060416","PROMETHAZINE ","SYP DM","120","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","",""],["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":""}]}]}