{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAIDER ALABBASI","gend":0,"add":"1230 PAUL ST","city":"HARRISONBURG","state":"VA","zip":"22801-9998","dob":"2003-11-21","age":"","mstatus":"","insh":"1440464*01","cliId":"","pno":"540\/271-2170","cno":"540\/209-7393","email":"","ename":"","eno":"","pphy":"DOMINGUS, JEFF DO","ppno":"540\/298-9900","pcpadd":"800 SHENANDOAH AVE SUITE 170","pcpcity":"ELKTON","pcpstate":"VA","pcpzip":22827,"pcpcounty":"","pcpid":"","pcpname":"Healthy Community Health Center - Stone Port (HCHC-Stone Port)","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/298-8991","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L70.0","T14.8XXD","J11.1","Z79.899","K21.9","K59.00","M41.9","Z20.828","M41.20","M54.5","M54.9","Z00.129","Z71.89","Z71.3","M62.89","J06.9","L90.5","H93.13","L20.84","L65.9","Z11.59","R07.89","R06.89"],"date":["2021-09-20","2019-12-15","2019-12-18","2020-05-28","2021-08-23","2021-08-23","2021-08-23","2021-02-08","2021-09-02","2021-09-02","2021-09-02","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2021-02-08","2021-09-20","2020-10-16","2019-04-29","2020-08-12","2020-08-12","2021-12-16","2021-12-16"],"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":[["","","CHLORHEX"," CHLORHEX ","473","Select","Select",""],["","","ISOTRETINOIN"," ISOTRETINOIN ","60","Select","Select",""],["","","RETIN-A"," RETIN-A ","45","Select","Select",""],["","","TRETINOIN"," TRETINOIN ","45","Select","Select",""],["","","CLINDAMYCIN"," CLINDAMYCIN ","60","Select","Select",""],["","","SELENIUM"," SELENIUM ","120","Select","Select",""],["","","DOXYCYCL"," DOXYCYCL ","60","Select","Select",""],["","","LORAZEPAM"," LORAZEPAM ","1","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","30","Select","Select",""],["","","TRIAMCINOLON"," TRIAMCINOLON ","30","Select","Select",""],["","","CLINDAMY\/BEN"," CLINDAMY\/BEN ","50","Select","Select",""],["","","MINOCYCLINE"," MINOCYCLINE ","60","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","6","Select","Select",""],["","","AMOX\/K"," AMOX\/K ","20","Select","Select",""],["","","CLARAVIS","CAP 40MG","","Select","Select",""],["","","PREDNISONE","TAB 10MG","","Select","Select",""],["","","LORATADINE","TAB 10MG","","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":""}]}]}