{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTINA   D TYREE","gend":1,"add":"C\/O LINDA ANTINUCCI 174 PAPA BEAR LN","city":"MADISON HEIGHTS","state":"VA","zip":"24572-9998","dob":"1998-04-01","age":"","mstatus":"","insh":"20036553*01","cliId":"","pno":"434\/846-8453","cno":"434\/846-8453","email":"","ename":"","eno":"","pphy":"HURST, MICHAEL MD","ppno":"434\/200-6401","pcpadd":"2402 ATHERHOLT ROAD","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24501,"pcpcounty":"","pcpid":142856,"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":["F41.1","Z30.49","Z01.419","Z30.40"],"date":["2021-10-22","2021-07-13","2020-09-04","2020-09-04"],"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":[["","00555906458","KELNOR ","Jan-35","28","Select","Select",""],["","13107008305","LORAZEPAM ","0.5MG","15","Select","Select",""],["","69097083512","SERTRALINE ","100MG","30","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","28","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","59762453802","MEDROXYPR ","150MG\/ML","1","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","00131247735","VIMPAT ","50MG","15","Select","Select",""],["","00555906458","KELNOR","Jan-35","28","Select","Select",""],["","69097083512","SERTRALINE","100MG","30","Select","Select",""],["","13107008305","LORAZEPAM","0.5MG","30","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","21","Select","Select",""],["","59762453802","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","00131247735","VIMPAT","50MG","15","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":""}]}]}