{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEVON   C FIELDS","gend":0,"add":"7411 WILLOUGHBY LN APT 101","city":"MANASSAS","state":"VA","zip":"20109-9998","dob":"1992-11-14","age":"","mstatus":"","insh":"2166363*01","cliId":"","pno":"804\/299-8328","cno":"804\/299-8328","email":"","ename":"","eno":"","pphy":"DOTSON, THOMAS C MD","ppno":"703\/361-5116","pcpadd":"10945 GEORGE MASON CIRCLE SUITE 105","pcpcity":"MANASSAS","pcpstate":"VA","pcpzip":20110,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"703\/361-5876","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R40.4","J96.21","J96.22","J81.0","R10.9","J15.212","J96.02","J96.01","I50.21","G93.41","E87.1","E87.2","B00.89","I42.8","F17.210","NO DATA","Z88.1","I11.0","R00.0","E83.42","H11.33","R11.2","J18.9","Z20.9","R53.83","R06.00","R06.82","R06.2","R06.02","J80.","I50.9","R07.9","I42.9","Z01.89","M25.511","Z87.01","Z86.59","Z98.890","Z87.891","M19.011","T50.901A","M65.811"],"date":["2020-02-24","2020-02-24","2020-02-24","2020-03-01","2020-09-03","2020-02-24","2020-02-26","2020-03-01","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-03-29","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-04-07","2020-01-24","2020-01-24","2020-02-24","2020-02-24","2020-02-24","2020-02-24","2020-03-01","2020-03-29","2020-08-07","2020-02-27","2020-02-27","2020-06-16","2020-03-29","2020-03-29","2020-03-29","2020-03-29","2020-07-21","2020-02-24","2020-05-07"],"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":[["","61442011201","ACYCLOVIR","TAB 400MG","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00054001825","PREDNISONE","TAB 20MG","18","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","6","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","60505264907","TIZANIDINE","CAP 4MG","7","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":""}]}]}