{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WHITNEY   M BAUBLITZ","gend":1,"add":"5026 LEWIS RD APT 15","city":"ROANOKE","state":"VA","zip":"24014-9998","dob":"1992-08-27","age":"","mstatus":"","insh":"2059049*01","cliId":"","pno":"540\/992-2509","cno":"540\/992-2509","email":"","ename":"","eno":"","pphy":"VOEKLER, SUSANNE E MD","ppno":"540\/977-0900","pcpadd":"4615 HUNTRIDGE ROAD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24012,"pcpcounty":"","pcpid":136562,"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":["F11.20","Z32.02","Z30.42","B18.2","K74.60","Z01.419","Z30.9","R10.2","R10.30","R11.0","K30.","Z87.42","R91.1","F17.210","R91.8","M54.9","G89.29","M79.89","Z23.","L02.412","L73.1","F15.20","Z65.3"],"date":["2021-11-16","2021-01-05","2021-09-16","2020-10-05","2020-09-04","2020-09-14","2020-04-15","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2020-01-21","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2021-09-03","2021-09-03","2021-07-14","2021-07-14"],"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":[["","00054017713","BUPRENORPHIN ","8MG","56","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","9","Select","Select",""],["","72626270101","SOFOS\/VELPAT ","400-100","28","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","10","Select","Select",""],["","65162074510","PROMETHAZINE ","12.5MG","12","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","15","Select","Select",""],["","61958220101","EPCLUSA ","400-100","28","Select","Select",""],["","00054017713","BUPRENORPHIN","8MG","56","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","15","Select","Select",""],["","68462010530","ONDANSETRON","4MG","9","Select","Select",""],["","65162074510","PROMETHAZINE","12.5MG","12","Select","Select",""],["","72626270101","SOFOS\/VELPAT","400-100","28","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","20","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","10","Select","Select",""],["","61958220101","EPCLUSA","400-100","28","Select","Select",""],["","68180012202","CEPHALEXIN ","CAP 500MG","20","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":""}]}]}