{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"COURTNEY   L CAMP","gend":1,"add":"342 ESNON RD","city":"CHASE CITY","state":"VA","zip":"23924-9998","dob":"2003-03-14","age":"","mstatus":"","insh":"8544271*01","cliId":"","pno":"434\/372-5517","cno":"434\/372-5517","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":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/372-8910","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H10.45","H40.023","H50.51","H52.03","Z30.42","R82.71","N89.8","R39.198","Z72.9","R56.9","R55.","Z11.3","Z20.828","Z30.8"],"date":["2020-09-14","2020-09-14","2020-09-14","2020-09-14","2020-09-09","2020-09-30","2020-10-27","2020-09-30","2020-09-30","2020-10-23","2020-10-23","2020-10-27","2021-06-09","2020-03-31"],"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":[["","59762453802","MEDROXYPR ","150MG\/ML","1","Select","Select",""],["","70710113908","FLUCONAZOLE ","150MG","2","Select","Select",""],["","31604001870","VITAMIN ","1000UNIT","90","Select","Select",""],["","59779014175","ACID ","10MG","30","Select","Select",""],["","16837087220","","","30","Select","Select",""],["","00555088602","ESTRADIOL ","1MG","7","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","35046001130","B-12 ","1000MCG","90","Select","Select",""],["","59762453802","MEDROXYPR","150MG\/ML","1","Select","Select",""],["","00555088602","ESTRADIOL","1MG","7","Select","Select",""],["","70710113908","FLUCONAZOLE","150MG","2","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","35046001130","B-12","1000MCG","90","Select","Select",""],["","80681016800","VITAMIN","25MCG","90","Select","Select",""],["","59779014175","ACID","10MG","30","Select","Select",""],["","00555902542","JUNEL ","TAB ","21","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":""}]}]}