{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAURETTA   S KEENE","gend":1,"add":"29427 HIGHWAY 49","city":"CHASE CITY","state":"VA","zip":"23924-9998","dob":"1981-05-08","age":"","mstatus":"","insh":"6541925*01","cliId":"","pno":"434\/414-5828","cno":"434\/414-5828","email":"","ename":"","eno":"","pphy":"SUSLICK, RANDALL H MD","ppno":"434\/372-5141","pcpadd":"946 N MAIN ST","pcpcity":"CHASE CITY","pcpstate":"VA","pcpzip":23924,"pcpcounty":"","pcpid":105512,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"434\/210-6424","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/372-8910","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G89.29","Z71.89","Z71.3","R70.0","R79.82","M54.41","M79.641","M79.642","I10.","F32.9","J32.9","M47.27","M54.2"],"date":["2020-10-02","2020-07-31","2020-07-31","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2021-03-12","2020-04-07","2020-04-07","2020-04-07","2020-10-14","2020-10-14"],"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":[["","69097094312","GABAPENTIN ","300MG","60","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","13668001005","CITALOPRAM ","20MG","30","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","69097015907","MELOXICAM ","15MG","30","Select","Select",""],["","50428028197","ALLERGY ","10MG","30","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","10","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","30","Select","Select",""],["","69097094312","GABAPENTIN","300MG","60","Select","Select",""],["","13668001005","CITALOPRAM","20MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","50428028197","ALLERGY","10MG","30","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","53489011905","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE ","TAB 150MG","1","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":""}]}]}