{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAREDA SIMMONS","gend":1,"add":"221 ROSS ST","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1974-10-14","age":"","mstatus":"","insh":"1884041*01","cliId":"","pno":3476099208,"cno":3476099208,"email":"","ename":"","eno":"","pphy":"MCCORMICK, PHYLLIS NP","ppno":4347914122,"pcpadd":"705 MAIN ST,","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4347914126,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S72.002A","I26.99","J18.9","W01.0XXA","S72.142A","NO DATA","D57.3","F17.200","D53.9","Z79.899","Z80.9","Z20.822","R52.","M79.605","Z47.89","S72.142D","M25.552","F17.210","R94.5","Z01.89","Z72.0","Z76.89","D64.9","E55.9","E53.8","F50.89","Z86.718","R60.0","Z79.01","I82.409","E87.1","R63.0","S72.145A","S72.92XS","R26.2","M16.12","Z71.6","R09.02","W19.XXXA","V54.13","M79.662","M79.89","S89.92XA","B37.0"],"date":["2021-04-03","2021-04-03","2021-04-03","2021-04-03","2022-01-27","2021-03-29","2022-12-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-06-15","2021-06-15","2021-06-15","2022-01-27","2021-04-01","2021-04-01","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-11-10","2022-12-29","2022-12-29","2022-12-29","2021-07-28","2022-05-12","2022-05-12","2021-05-20","2021-04-22","2021-04-22","2021-04-22","2021-06-24","2021-03-29","2021-03-29","2021-05-20","2021-06-09","2021-06-09","2022-10-26","2022-10-26"],"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":[["","64380016001","MEGESTROL AC","SUS 40MG\/ML","600","Select","Select",""],["","00536589488","NICOTINE TD","DIS 7MG\/24HR","28","Select","Select",""],["","00245010810","FERROUS SULF","TAB 325MG EC","30","Select","Select",""],["","0","COMPOUND"," ","160","Select","Select",""],["","60432053716","NYSTATIN","SUS 100000","140","Select","Select",""],["","00904759180","FEROSUL","TAB 325MG","30","Select","Select",""],["","13107000105","MIRTAZAPINE","TAB 7.5MG","30","Select","Select",""],["","70000034801","NICOTINE POL","GUM 2MG MINT","40","Select","Select",""],["","40985027139","VITAMIN D3","TAB 1000UNIT","30","Select","Select",""],["","11534016503","FOLIC ACID","TAB 1MG","30","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","64380016001","MEGESTROL AC SUS","40MG\/ML","600","Select","Select",""],["","00536589488","NICOTINE TD DIS","7MG\/24HR","28","Select","Select",""],["","00245010810","FERROUS SULF TAB","325MG EC","30","Select","Select",""],["","30768019995","VITAMIN D","3 CAP 1000UNIT","90","Select","Select",""],["","45802048678","DOCUSATE SOD CAP","100MG","60","Select","Select",""],["","60432053716","NYSTATIN SUS","100000","140","Select","Select",""],["","11534016503","FOLIC ACID TAB","1MG","30","Select","Select",""],["","70000034801","NICOTINE POL GUM","2MG MINT","40","Select","Select",""],["","13107000105","MIRTAZAPINE TAB","7.5MG","30","Select","Select",""],["","00904759180","FEROSUL TAB","325MG","30","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":""}]}]}