{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALNESIA WARREN","gend":1,"add":"1301 PARK AVE APT 300","city":"LYNCHBURG","state":"VA","zip":"24501-9998","dob":"1972-02-13","age":"","mstatus":"","insh":"2206819*01","cliId":"","pno":"919\/864-6529","cno":"919\/864-6529","email":"","ename":"","eno":"","pphy":"KADREE, MARGARET A MD","ppno":"434\/947-5967","pcpadd":"320 FEDERAL STREET","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24504,"pcpcounty":"","pcpid":972504,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R13.10","K29.50","J30.1","J30.81","J30.89","F33.0","F41.9","F32.2","F41.1","R35.0","Z13.0","Z13.228","E55.9","Z13.220","E78.5","Z71.9","R10.11","K21.9","K29.70","B96.81","Z11.59","R07.0","R11.0","R68.81","Z28.21","J30.9","L50.9","Z91.018","K22.2"],"date":["2021-07-23","2021-07-23","2021-08-23","2021-08-23","2021-08-23","2020-11-24","2021-07-23","2020-02-25","2020-02-25","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2021-04-26","2020-09-25","2021-01-14","2020-01-07","2020-01-07","2021-04-19","2021-01-14","2020-09-25","2020-09-25","2020-09-25","2021-02-22","2021-02-22","2021-02-22","2021-07-23"],"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":[["","62175013643","OMEPRAZOLE ","40MG","30","Select","Select",""],["","62175089143","ATORVASTATIN ","20MG","30","Select","Select",""],["","16729016917","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00591079410","DICYCLOMINE ","10MG","90","Select","Select",""],["","60505083305","AZELASTINE ","0.10%","30","Select","Select",""],["","45802010901","TRIAMCINOLON ","55MCG\/AC","17","Select","Select",""],["","00172572960","FAMOTIDINE ","40MG","30","Select","Select",""],["","43199001101","HYOSCYAMINE ","0.125MG","60","Select","Select",""],["","10006070127","VITAMIN ","125MCG","90","Select","Select",""],["","69230030001","ALLERGY ","180MG","30","Select","Select",""],["","80777027398","MODERNA ","COVID-19","0","Select","Select",""],["","49502050002","EPIPEN ","0.3MG","2","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":""}]}]}