{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAFAR   B MANSOOR","gend":0,"add":"1410 OLD WINDMILL CIR","city":"HARRISONBURG","state":"VA","zip":"22802-9998","dob":"2004-01-15","age":"","mstatus":"","insh":"1284474*01","cliId":"","pno":"540\/434-3049","cno":"540\/246-3904","email":"","ename":"","eno":"","pphy":"LEPLEY, SHAWN M MD","ppno":"540\/564-7300","pcpadd":"1661 S MAIN ST","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara South Main Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/431-7100","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","Z11.1","H40.053","H52.13","H52.203","R93.89","Z23.","Q82.8","L85.8","J06.9","J02.9","Z20.822","Z00.129","F32.9","E66.9","Z71.3","Z71.82","Z68.54"],"date":["2022-07-05","2022-07-05","2022-05-18","2022-05-18","2021-04-14","2022-05-18","2021-08-03","2021-08-23","2021-08-23","2020-03-03","2021-08-25","2021-08-25","2021-08-10","2021-08-10","2021-10-18","2021-10-18","2021-10-18","2021-10-18"],"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":[]},{"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":[["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","45802049383","AMMONIUM","CRE 0.12","280","Select","Select",""],["","00299391702","CETAPHIL","CRE MOISTURE","170","Select","Select",""],["","00168000680","TRIAMCINOLON","OIN 0.001","80","Select","Select",""],["","63629204001","UREA","LOT 0.4","227","Select","Select",""],["","00126007492","PREVDNT","PST 0.011","100","Select","Select",""],["","00603233832","APAP\/CODEINE","TAB 300-30MG","16","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","15","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","24","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","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":""}]}]}