{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHADESTINY JOHNSON","gend":1,"add":"3536 TIMBER RIDGE DR APT 103","city":"FREDERICKSBURG","state":"VA","zip":"22408-9998","dob":"2001-10-13","age":"","mstatus":"","insh":"7823487*01","cliId":"","pno":"434\/882-5207","cno":"434\/882-5207","email":"","ename":"","eno":"","pphy":"KEELEY, MEG G MD","ppno":"434\/924-5321","pcpadd":"1221 LEE STREET","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":22908,"pcpcounty":"","pcpid":971083,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/982-3816","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N76.0","Z72.51","K21.0","B96.89","B37.3","Z30.8","Z11.3","U07.1","R07.0","R43.9","R05.","R53.83","G47.9","Z23.","Z00.01","B37.9","N89.8","Z71.3","Z68.54","Z13.31","J35.8","Z86.19","K64.4"],"date":["2021-07-08","2021-01-28","2020-02-11","2020-09-08","2021-04-05","2021-04-05","2021-07-29","2020-08-21","2020-08-19","2020-08-19","2020-08-21","2020-08-21","2020-09-24","2020-09-24","2020-08-04","2020-08-04","2021-01-28","2020-08-04","2020-08-04","2020-08-04","2020-11-24","2021-01-28","2020-03-26"],"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":[["","45802048678","DOCUSATE ","100MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","59779073041","CVS ","7","45","Select","Select",""],["","68180016113","AZITHROMYCIN ","500MG","2","Select","Select",""],["","42002030268","TUCKS ","","40","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","59779074701","MEDICATED ","PADS","50","Select","Select",""],["","00555901658","SPRINTEC ","28 DAY","28","Select","Select",""],["","51672127502","CLOTRIMAZOLE ","1%","30","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","10","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":""}]}]}