{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TASSIE M BRADLEY","gend":1,"add":"115 BEAUFORT ST APT H62","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1995-07-21","age":"","mstatus":"","insh":"1005423*01","cliId":"","pno":4344219455,"cno":4344219455,"email":"","ename":"","eno":"","pphy":"PACIFICO, MICAH NP","ppno":4348354876,"pcpadd":"949 PINEY FOREST RD,","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541-9998","pcpcounty":"","pcpid":"","pcpname":"GoDocs","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4348354875,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F39.","N39.0","F41.9","J06.9","I10.","J45.909","Z20.822","F31.2","F20.9","F25.0","F12.20","Z30.42","Z32.02","F25.9","F33.2","V62.84","F17.210","F29.","Z00.00","Z12.4","U07.1","J10.1","B96.89","Z88.8","Z91.040","L30.9","L30.8","Z71.6"],"date":["2022-06-01","2022-06-03","2022-08-18","2021-12-06","2022-06-14","2021-12-06","2022-05-31","2022-05-03","2022-05-03","2022-06-30","2022-06-15","2022-03-07","2022-03-07","2022-06-10","2022-06-03","2022-06-03","2022-06-14","2022-06-03","2021-11-03","2021-11-03","2022-01-11","2022-01-11","2022-05-31","2022-05-31","2022-05-31","2023-06-26","2023-07-17","2022-06-14"],"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":[["","55111016605","OLANZAPINE","TAB 10MG","30","Select","Select",""],["","67877024910","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","00115180402","HYDROXYZ PAM","CAP 50MG","60","Select","Select",""],["","62756079888","DIVALPROEX","TAB 500MG DR","60","Select","Select",""],["","50111056002","TRAZODONE","TAB 50MG","15","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","79854000615","MELATONIN","SUB 5MG","30","Select","Select",""],["","00228212710","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00378064210","PREDNISONE","20 MG","10","Select","Select",""],["","55111028130","LEVOFLOXACIN","750 MG","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":""}]}]}