{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEAIGO   T ROE","gend":0,"add":"7602 SPRENKLE CT","city":"HENRICO","state":"VA","zip":"23228-9998","dob":"1982-12-13","age":"","mstatus":"","insh":"1897935*01","cliId":"","pno":"804\/309-7749","cno":"804\/309-7749","email":"","ename":"","eno":"","pphy":"BROWN, LESLI A MD","ppno":"804\/526-1111","pcpadd":"SUITE 300 4700 PUDDLEDOCK ROAD","pcpcity":"PRINCE GEORGE","pcpstate":"VA","pcpzip":23875,"pcpcounty":"","pcpid":"","pcpname":"PrimeCare Family Practice","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/526-2978","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R21.","B20.","I10.","Z79.899","Z91.012","Z91.013","Z87.891","J06.9","R09.81","J01.30","R51.","M54.2","Z53.20","M54.5","Z21."],"date":["2020-04-28","2020-04-30","2020-07-31","2020-04-28","2020-07-31","2020-07-31","2020-04-30","2020-02-04","2020-02-04","2020-02-24","2020-02-27","2020-02-27","2020-02-27","2020-07-31","2020-07-31"],"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":[["","65862042001","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","61958190101","GENVOYA","TAB ","30","Select","Select",""],["","64679092402","ENALAPRIL","TAB 5MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00781194339","AMOX-POT","TAB ER","28","Select","Select",""],["","00591264001","BUT\/APAP\/CAF","CAP ","3","Select","Select",""],["","00472037915","CLOTRIM\/BETA","CRE DIPROP","30","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","60","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":""}]}]}