{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAZMINE PENN","gend":1,"add":"180 SHIP SHOAL WAY","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1993-04-01","age":"","mstatus":"","insh":"8570035*01","cliId":"","pno":"757\/344-7009","cno":"757\/344-7009","email":"","ename":"","eno":"","pphy":"LEPAGE, JOSEPH T MD","ppno":"757\/721-0512","pcpadd":"HPT RDS-CONTRACT REP 5000 COX RD ST","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":125384,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/968-4243","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.99","F41.9","Z30.9","Z30.017","R87.612","Z32.02","Z87.891","M54.9","R19.7","N76.0","B96.89","N94.6","J06.9","Z20.822","Z20.828"],"date":["2020-05-06","2020-05-06","2020-11-03","2020-11-03","2020-06-10","2020-06-10","2021-06-29","2021-06-29","2021-06-29","2020-04-01","2020-04-01","2021-05-04","2021-07-08","2021-07-08","2021-09-07"],"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":[["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","65862077685","MILI ","0.25\/35","28","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","70700011985","ESTARYLLA ","0.25-35","84","Select","Select",""],["","67877057305","BENZONATATE ","100MG","15","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","14","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","65862077685","MILI","0.25\/35","28","Select","Select",""],["","70700011985","ESTARYLLA","0.25-35","84","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","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":""}]}]}