{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AAYANA JONES","gend":1,"add":"2535 MOSBY CT APT B","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"2003-11-13","age":"","mstatus":"","insh":"9018034*01","cliId":"","pno":"540\/209-0960","cno":"540\/209-0960","email":"","ename":"","eno":"","pphy":"LOUCKS, AMANDA M MD","ppno":"540\/433-9151","pcpadd":"1831 RESERVOIR STREET","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":113977,"pcpname":"Harrisonburg Family Practice Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/433-0547","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.011","R21.","O03.4","O20.0","Z3A.00","Z20.828","F33.8","N83.209","J01.00","O03.9","Z30.9","N83.202","M79.676","R30.0","N94.6","Z32.02","M54.9","M41.9","NO DATA"],"date":["2020-03-30","2020-03-30","2020-08-14","2020-08-12","2020-08-12","2020-10-13","2020-12-17","2020-12-17","2020-01-28","2020-08-25","2020-11-12","2020-11-12","2020-09-02","2020-09-02","2021-09-02","2021-09-02","2021-10-29","2021-10-29","2021-10-29"],"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":[["","00555902858","JUNEL ","1.5\/30","28","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00168000215","TRIAMCINOLON ","0.50%","15","Select","Select",""],["","65862077685","MILI ","0.25\/35","28","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","7","Select","Select",""],["","13668001005","CITALOPRAM ","20MG","30","Select","Select",""],["","65862050320","AMOX\/K ","875-125","14","Select","Select",""],["","16729021616","SERTRALINE ","50MG","30","Select","Select",""],["","70700011885","VIENVA ","0.1-20","28","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","00555902858","JUNEL","1.5\/30","28","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","00168000215","TRIAMCINOLON","0.50%","15","Select","Select",""],["","65862077685","MILI","0.25\/35","28","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","7","Select","Select",""],["","70700011885","VIENVA","0.1-20","28","Select","Select",""],["","16729021616","SERTRALINE","50MG","30","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","13668001005","CITALOPRAM","20MG","30","Select","Select",""],["","68180086671","BLISOVI","1.5\/30","84","Select","Select",""],["","51862087006","MICROGESTIN","FE1.5\/30","84","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","51862087006","MICROGESTIN ","TAB FE1.5\/30","84","Select","Select",""],["","68180086671","BLISOVI ","TAB 1.5\/30","84","Select","Select",""],["","16729044315","BUPROPN ","TAB 150MG XL","30","Select","Select",""],["","52817033200","CYCLOBENZAPR ","TAB 10MG","10","Select","Select",""],["","00591544305","PREDNISONE ","TAB 20MG","14","Select","Select",""],["","65862094188","AUROVELA ","TAB 1.5\/30","28","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":""}]}]}