{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SEAN SMITH","gend":0,"add":"2435 HUGUENOT SPRING ROAD PO BOX 194","city":"MIDLOTHIAN","state":"VA","zip":"23113-9998","dob":"2002-05-25","age":"","mstatus":"","insh":"8062390*01","cliId":"","pno":"804\/379-4108","cno":"804\/379-4108","email":"","ename":"","eno":"","pphy":"CANTOR, DEBRA K DO","ppno":"804\/378-4420","pcpadd":"13925 COALFIELD COMMONS PL STE 201","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":23114,"pcpcounty":"","pcpid":131141,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/378-4440","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.00","F29.","I10.","F32.9","R45.4","F17.210","F99.","F33.3","S60.221A","V62.84","Z11.59","W22.8XXA","Y92.89","Y93.89","Z62.810","F17.200","Z20.828"],"date":["2020-08-22","2020-08-22","2020-08-22","2021-04-15","2021-04-15","2021-04-15","2021-04-15","2020-09-09","2020-08-21","2020-08-22","2020-08-21","2020-08-21","2020-08-21","2020-08-21","2020-08-22","2020-08-22","2020-08-24"],"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":[["","68180072003","AMLODIPINE ","5MG","15","Select","Select",""],["","13668013601","ESCITALOPRAM ","10MG","30","Select","Select",""],["","43547034006","RISPERIDONE ","0.5MG","30","Select","Select",""],["","68180072003","AMLODIPINE","5MG","15","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","43547034006","RISPERIDONE","0.5MG","30","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":""}]}]}