{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIANNA   F CAMPBELL","gend":1,"add":"1085 DILLON WAY","city":"BEDFORD","state":"VA","zip":"24523-9998","dob":"2004-06-23","age":"","mstatus":"","insh":"9449477*01","cliId":"","pno":"434\/258-6219","cno":"","email":"","ename":"","eno":"","pphy":"MINOTTI, CRISTINA MARIA FNP","ppno":"434\/528-0005","pcpadd":"925 VILLAGE HWY","pcpcity":"RUSTBURG","pcpstate":"VA","pcpzip":24588,"pcpcounty":"","pcpid":"","pcpname":"JOHNSON HEALTH CENTER","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/528-0004","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.2","R05.","R09.81","H66.90","R51.9","Z20.822","J45.42"],"date":["2021-06-27","2021-06-27","2021-06-27","2021-09-14","2021-11-22","2021-09-26","2021-11-22"],"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":[["","51862056406","LOW-OGESTREL","TAB ","28","Select","Select",""],["","00555904958","CRYSELLE-28","TAB 28 TABS","84","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","59651000815","AZITHROMYCIN","SUS 200\/5ML","75","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00085113201","PROVENTIL","AER HFA","7","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","128","Select","Select",""],["","00781604146","AMOXICILLIN","SUS 250\/5ML","300","Select","Select",""],["","50580053604","SUDAFED","LIQ 15MG\/5ML","140","Select","Select",""],["","65862056890","MONTELUKAST","CHW 5MG","60","Select","Select",""],["","00536124207","ANTIHISTAMIN","TAB 60-120MG","30","Select","Select",""],["","00054372763","PROPRANOLOL","SOL 20MG\/5ML","300","Select","Select",""],["","50383004224","PREDNISOLONE","SOL 15MG\/5ML","100","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":""}]}]}