{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LANESHA CLEMONS","gend":1,"add":"301 FAIRVIEW DR","city":"FRANKLIN","state":"VA","zip":"23851-9998","dob":"1977-09-09","age":"","mstatus":"","insh":"8939675*01","cliId":"","pno":"757\/323-1783","cno":"757\/323-1783","email":"","ename":"","eno":"","pphy":"KAPOOR, SONIA MD","ppno":"757\/548-0076","pcpadd":"SUITE 100 725 VOLVO PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":134965,"pcpname":"Family Physicians of Chesapeake","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-4652","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M76.822","M24.572","M24.571","M79.672","M54.5","I73.9","M25.572","D24.1","N60.91","M25.562","N64.4","M47.816","M54.17","G60.3","R20.2","S16.1XXA","M54.6","L72.3","L81.9","F41.9","R23.0","E55.9","N62.","M94.262","NO DATA"],"date":["2020-10-30","2020-10-30","2020-10-30","2020-10-30","2021-05-17","2021-05-21","2020-09-04","2021-09-27","2021-05-26","2021-10-18","2021-07-26","2021-04-29","2020-11-13","2020-11-13","2020-11-13","2021-02-02","2021-01-29","2021-04-16","2021-05-21","2021-10-18","2021-10-18","2021-10-18","2021-09-27","2021-08-24","2021-10-18"],"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":[["","16714007104","BACLOFEN ","10MG","90","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","12","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","70","Select","Select",""],["","16729017217","AMITRIPTYLIN ","25MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR ","10MG","20","Select","Select",""],["","49035090410","","","40","Select","Select",""],["","65162019011","NAPROXEN ","500MG","60","Select","Select",""],["","16714007104","BACLOFEN","10MG","90","Select","Select",""],["","64380073706","VITAMIN","50000UNT","12","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","70","Select","Select",""],["","16729017217","AMITRIPTYLIN","25MG","30","Select","Select",""],["","65162019011","NAPROXEN","500MG","20","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","20","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":""}]}]}