{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMESHA   L BENNETT","gend":1,"add":"422 OVERBY ST","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"2002-08-04","age":"","mstatus":"","insh":"8227306*01","cliId":"","pno":"434\/483-7963","cno":"434\/483-7963","email":"","ename":"","eno":"","pphy":"OMOJI, BASSEY MD","ppno":"434\/793-7745","pcpadd":"SUITE B 140 PINEY FOREST RD","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24540,"pcpcounty":"","pcpid":105919,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"434\/228-5807","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":["F34.81","N76.0","R21.","R07.9","Y04.8XXA","Z00.00","Z30.012","Z32.02","R51.","Z53.20","Z20.828","A52.8","R52.","R60.9","S61.551A","S23.41XA"],"date":["2020-12-28","2020-07-24","2020-07-24","2020-09-28","2020-09-28","2021-05-24","2021-06-22","2021-06-22","2020-07-06","2020-07-06","2020-11-14","2021-07-07","2020-07-06","2020-07-06","2020-09-28","2020-09-28"],"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":[["","00555902658","JUNEL ","Jan-20","84","Select","Select",""],["","61442011201","ACYCLOVIR ","400MG","60","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","71093014005","METHOCARBAM ","500MG","40","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","49483060350","IBUPROFEN ","600MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR ","1GM","30","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","1","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","56","Select","Select",""],["","00555902658","JUNEL","Jan-20","84","Select","Select",""],["","61442011201","ACYCLOVIR","400MG","60","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","14","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","49483060350","IBUPROFEN","600MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","1","Select","Select",""],["","31722070530","VALACYCLOVIR","1GM","30","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","53489011905","DOXYCYCL","100MG","56","Select","Select",""],["","71093014005","METHOCARBAM","500MG","40","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":""}]}]}