{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JULIE PINTO","gend":1,"add":"13000 CARTERS HILL CT","city":"CHESTERFIELD","state":"VA","zip":"23838-9998","dob":"1967-12-30","age":"","mstatus":"","insh":"2153537*01","cliId":"","pno":"401\/527-8988","cno":"401\/527-8988","email":"","ename":"","eno":"","pphy":"BRYAN, DAPHNE L MD","ppno":"804\/276-9305","pcpadd":"2500 POCOSHOCK PL","pcpcity":"NORTH CHESTERFIELD","pcpstate":"VA","pcpzip":23235,"pcpcounty":"","pcpid":208011,"pcpname":"BON SECOURS CHESTERFIELD FAMILY MEDICINE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/674-4145","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","E78.2","F32.89","F43.20","F34.89","B35.9","R94.31","K80.12","N28.1","Z88.0","Z88.2","Z90.710","R16.0","Z79.899","K80.00","K81.0","K81.9"],"date":["2020-02-10","2020-02-10","2020-08-07","2021-03-10","2020-08-14","2020-11-19","2020-01-14","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-15","2020-01-14"],"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":[["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","16571040250","CETIRIZINE ","10MG","30","Select","Select",""],["","42571012290","LEVOCETIRIZI ","5MG","30","Select","Select",""],["","49035045875","ALLERGY ","10MG","90","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120","Select","Select",""],["","70710112307","DOXYCYC ","100MG","20","Select","Select",""],["","42858000101","OXYCODONE ","5MG","10","Select","Select",""],["","42858000101","OXYCODONE","5MG","10","Select","Select",""],["","16571040250","CETIRIZINE","10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","42571012290","LEVOCETIRIZI","5MG","30","Select","Select",""],["","49035045875","ALLERGY","10MG","90","Select","Select",""],["","70710112307","DOXYCYC","100MG","20","Select","Select",""],["","51672129801","KETOCONAZOLE","2%","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","",""],["N\/A","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":""}]}]}