{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DREAMA   K MELTON","gend":1,"add":"69 DWELLYS LN","city":"CHURCHVILLE","state":"VA","zip":"24421-9998","dob":"1988-01-23","age":"","mstatus":"","insh":"9786732*01","cliId":"","pno":"540\/688-9246","cno":"540\/688-9246","email":"","ename":"","eno":"","pphy":"TRAN, GEORGE MD","ppno":"540\/245-7806","pcpadd":"3881 CHURCHVILLE AVE","pcpcity":"CHURCHVILLE","pcpstate":"VA","pcpzip":24421,"pcpcounty":"","pcpid":165426,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/213-9264","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z80.3","Z98.890","R92.2","F41.8","K14.9","N64.59","S93.402A","W10.9XXA","R92.8","Z13.79","Z15.01","NO DATA","Z00.00","Z84.81","M43.16","Z12.39","Z85.43","Z80.41","B37.0","C50.919","R46.89","Z91.89","S81.812A","W01.198A","Z23."],"date":["2020-11-05","2020-11-05","2020-11-05","2021-06-08","2021-06-08","2020-03-05","2020-06-03","2020-06-03","2020-06-25","2020-02-20","2020-02-20","2020-03-11","2020-03-11","2020-03-11","2020-03-11","2020-03-16","2020-03-16","2020-07-09","2020-11-13","2020-06-25","2020-03-05","2020-03-05","2021-08-16","2021-08-16","2021-08-16"],"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":[["","68645052254","SERTRALINE ","50MG","30","Select","Select",""],["","00527512170","NYSTATIN ","100000","140","Select","Select",""],["","00527512170","NYSTATIN","100000","140","Select","Select",""],["","68645052254","SERTRALINE","50MG","30","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","15","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":""}]}]}