{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEENEN  D SMITH","gend":0,"add":"13123 JEFFERSON DAVIS HWY","city":"WOODFORD","state":"VA","zip":22580,"dob":"1991-01-22","age":"","mstatus":"","insh":"20035219*01","cliId":"","pno":"540\/786-6223","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"540\/374-3290","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":22580,"pcpcounty":"","pcpid":"","pcpname":"MARY WASHINGTON HEALTHCARE PHYSICIANS","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/374-3289","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.9","E11.29","R80.9","Z79.4","E11.22","E78.2","E03.9","E11.21","F84.0","Z72.0","Z79.899","E11.65","F25.9","F31.9","Z91.89","R56.9","F91.9","E11.9"],"date":["2022-10-26","2021-11-15","2021-11-15","2022-11-17","2020-09-24","2021-10-13","2021-07-13","2021-10-13","2021-10-13","2021-10-13","2021-04-13","2019-09-23","2019-06-17","2022-09-16","2022-09-16","2022-09-20","2022-09-20","2022-11-17"],"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":[["","62756079888","DIVALPROEX","TAB 500MG DR","60","Select","Select",""],["","00054002125","LITHIUM","TAB 300MG ER","30","Select","Select",""],["","69315013601","BENZTROPINE","TAB 0.5MG","60","Select","Select",""],["","65862019301","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","","ARIPIPRAZOLE","TAB 5MG","","Select","Select",""],["","00781518092","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","00228300411","CLONAZEPAM","TAB 1MG","30","Select","Select",""],["","00093725501","GLIMEPIRIDE","TAB 2MG","30","Select","Select",""],["","53191036201","D3-50","CAP 50000UNT","4","Select","Select",""],["","65862001001","METFORMIN","TAB 1000MG","60","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","2","Select","Select",""],["","68382007901","HALOPERIDOL","TAB 5MG","90","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","19515080852","FLULAVAL","INJ 2022-23","0","Select","Select",""],["","","LORAZEPAM","TAB 0.5MG","","Select","Select",""],["","75834002012","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00378097301","CLOZAPINE","TAB 200MG","30","Select","Select",""],["","00591040601","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","","SHARPS","MIS 6.9QT","","Select","Select",""],["","","ONE","KIT VERIO FL","","Select","Select",""],["","53885027025","ONETOUCH","TES VERIO","25","Select","Select",""],["","50458056401","INVEGA","INJ 234\/1.5","2","Select","Select",""],["","13668003660","RISPERIDONE","TAB 0.5MG","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}