{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAQUATA SPENCER","gend":1,"add":"135 SWANSON ST","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1981-02-23","age":"","mstatus":"","insh":"1129993*01","cliId":"","pno":"434\/251-3384","cno":"434\/349-9870","email":"","ename":"","eno":"","pphy":"SIEGE, KAREN PA","ppno":"434\/200-7210","pcpadd":"414 PARK AVE","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/200-7211","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.901","Z20.828","R06.00","J44.9","R19.7","F33.2","R07.9","R10.30","N83.209","I10.","R10.9","R03.0","R32.","R05.","H43.393","H52.223"],"date":["2019-08-22","2020-07-01","2021-09-16","2021-09-16","2021-09-16","2019-04-26","2021-07-19","2021-07-19","2021-07-19","2021-07-19","2021-07-16","2021-07-16","2021-07-16","2020-07-01","2021-02-22","2021-02-22"],"priorHcc":["","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","MIRTAZAPINE"," MIRTAZAPINE ","15","Select","Select",""],["","","VENLAFAXINE"," VENLAFAXINE ","30","Select","Select",""],["","","BUSPIRONE"," BUSPIRONE ","45","Select","Select",""],["","","DOXYCYCL"," DOXYCYCL ","2","Select","Select",""],["","","HYDROXYZ"," HYDROXYZ ","60","Select","Select",""],["","","FENOFIBRATE"," FENOFIBRATE ","30","Select","Select",""],["","","BROM\/PSE\/DM","SYP ","","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}