{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA   L BALLARD","gend":1,"add":"2610 GRANT ST","city":"HOPEWELL","state":"VA","zip":"23860-9998","dob":"1993-04-01","age":"","mstatus":"","insh":"1907564*01","cliId":"","pno":"804\/243-4829","cno":"","email":"","ename":"","eno":"","pphy":"MAGNIN, ALBERT MD","ppno":"804\/458-8557","pcpadd":"815 W POYTHRESS ST","pcpcity":"HOPEWELL","pcpstate":"VA","pcpzip":23860,"pcpcounty":"","pcpid":"","pcpname":"Appomatox River Primary Care, LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/541-7113","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F32.9","F43.10","F40.10","G43.019","G44.40","G44.52","F41.9","E66.3","G43.109","K04.7","F90.0","D50.9","F33.1","S46.911A","Z30.017","L30.9","F33.2","F41.1","F60.3","F90.2","Z62.891","Z62.820","Z62.810","Z65.4","Z60.9","Z56.9","R19.7","F32.0"],"date":["2021-04-05","2020-12-02","2020-12-02","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-12-08","2020-11-30","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2020-03-12","2020-09-28","2019-01-10","2019-11-05","2019-01-10","2019-01-10","2019-01-10","2019-01-10","2019-01-10","2019-01-10","2019-01-10","2019-01-10","2019-07-16","2019-07-29"],"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":[["","69097012215","TOPIRAMATE","TAB 25MG","30","Select","Select",""],["","45802006405","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","00093005305","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","16714079801","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","24","Select","Select",""],["","00074709630","QULIPTA","TAB 30MG","30","Select","Select",""],["","","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","","BUT\/APAP\/CAF","TAB ","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","68382095501","AMPHET\/DEXTR","TAB 20MG","30","Select","Select",""],["","68462024805","RANITIDINE","TAB 150MG","60","Select","Select",""],["","00527128210","DICYCLOMINE","TAB 20MG","120","Select","Select",""],["","00115165903","PROPRANOLOL","TAB 10MG","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":""}]}]}