{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KYLA   M JOHNSON","gend":1,"add":"520 ROSLYN AVE","city":"COLONIAL HEIGHTS","state":"VA","zip":"23834-9998","dob":"2002-05-01","age":"","mstatus":"","insh":"7914725*01","cliId":"","pno":"804\/490-2991","cno":"804\/490-2991","email":"","ename":"","eno":"","pphy":"IQBAL, JAWED MD","ppno":"804\/520-2600","pcpadd":"16011 KAIROS ROAD","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":23834,"pcpcounty":"","pcpid":671128,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"804\/504-6668","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/520-5853","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05.","R09.81","J30.9","N89.8","Z3A.08","Z34.01","Z34.90","Z20.828","N91.2","Z32.01","B37.3","Z23.","J45.909","Z01.419","L20.9","O80.","Z01.812"],"date":["2020-06-01","2020-06-01","2020-03-05","2020-05-14","2021-02-08","2021-02-08","2021-02-08","2021-01-04","2021-02-01","2021-02-01","2020-03-04","2021-07-06","2020-11-02","2020-09-22","2021-03-18","2021-09-19","2021-09-08"],"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":[["","69842000003","FLUTICASONE ","50MCG","10","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","45802057178","FEXOFENADINE ","180MG","30","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","68462019255","MOMETASONE ","0.10%","45","Select","Select",""],["","11523716203","CLARITIN-D ","5-120MG","30","Select","Select",""],["","00555902658","JUNEL ","Jan-20","28","Select","Select",""],["","74312031644","PROBIOTIC ","ADVANCED","30","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","2","Select","Select",""],["","45802071708","TERCONAZOLE ","80MG","3","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","20","Select","Select",""],["","68462019217","MOMETASONE","0.10%","45","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","45802057178","FEXOFENADINE","180MG","30","Select","Select",""],["","00378827052","ALBUTEROL","0.08%","75","Select","Select",""],["","69842000003","FLUTICASONE","50MCG","10","Select","Select",""],["","00555902658","JUNEL","Jan-20","28","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","11523716203","CLARITIN-D","5-120MG","30","Select","Select",""],["","45802065078","LORATADINE","10MG","90","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","20","Select","Select",""],["","45802071708","TERCONAZOLE","80MG","3","Select","Select",""],["","49483060450","IBUPROFEN","800MG","60","Select","Select",""],["","74312031644","PROBIOTIC","ADVANCED","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","28","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","60","Select","Select",""],["","00093767902","ETONOGESTREL ","MIS ETHY EST","1","Select","Select",""],["","53746010901","HYDROCO\/APAP ","TAB 5-325MG","28","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":""}]}]}