{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PRINCESS HAIRSTON","gend":1,"add":"154 ALLISON DR","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1991-08-12","age":"","mstatus":"","insh":"9242392*01","cliId":"","pno":"434\/907-9387","cno":"434\/907-9387","email":"","ename":"","eno":"","pphy":"LORD, ARCHIBALD L MD","ppno":"434\/947-3944","pcpadd":"2215 LANDOVER PLACE","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24501,"pcpcounty":"","pcpid":105594,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","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":["F33.1","F43.12","J45.21","J06.9","J45.909","Z20.828","J45.901","B34.9","Z87.891","K02.9","Z91.013","K08.89","R68.84","S83.90XA","I07.1","S26.90XS","J03.90","Z20.822","J20.9"],"date":["2020-10-08","2020-10-08","2020-11-10","2020-10-07","2020-10-07","2021-03-22","2021-03-22","2021-03-22","2020-10-02","2020-04-11","2020-04-11","2020-04-21","2020-04-21","2020-10-28","2020-11-24","2020-11-24","2021-08-11","2021-09-10","2021-09-10"],"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":[["","65862001705","AMOXICILLIN ","500MG","30","Select","Select",""],["","68462019005","NAPROXEN ","500MG","30","Select","Select",""],["","66685100100","AMOX\/K ","875-125","20","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","00173085910","BREO ","100-25","60","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","10","Select","Select",""],["","00591544210","PREDNISONE ","10MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00173071920","FLOVENT ","110MCG","12","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","64380071206","BENZONATATE ","100MG","15","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","30","Select","Select",""],["","68462019005","NAPROXEN","500MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00591544305","PREDNISONE","20MG","10","Select","Select",""],["","00173085910","BREO","100-25","60","Select","Select",""],["","64380080807","IBUPROFEN","600MG","30","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","68462010530","ONDANSETRON","4MG","10","Select","Select",""],["","64380071206","BENZONATATE","100MG","15","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","7","Select","Select",""],["","51224002250","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","63824005718","MUCINEX ","TAB 60-600MG","40","Select","Select",""],["","60432060416","PROMETHAZINE ","SYP DM","210","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":""}]}]}