{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"XAVIER T KELLEY","gend":0,"add":"2000 FRANKLIN TPKE","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"2003-07-01","age":"","mstatus":"","insh":"20030525*01","cliId":"","pno":4347282367,"cno":4347282367,"email":"","ename":"","eno":"","pphy":"WILLIAMS, KATIE B NP","ppno":4347992111,"pcpadd":"STE 2100 201 S MAIN STREET,","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541-9998","pcpcounty":"","pcpid":"","pcpname":"Sovah Pediatrics - Danville","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4347992297,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z98.890","Z95.818","Q20.4","Q21.1","Q22.0","K76.9","Q20.1","Z91.89","Q20.3","J02.9","U07.1","Q25.6","R00.1","Q26.2","Q24.0","R79.89","N28.1","Z00.00","F81.9","Z00.129","Q66.6","M79.671","M79.672","R74.8"],"date":["2023-05-25","2022-11-11","2022-12-28","2022-01-03","2022-05-13","2021-10-08","2021-10-08","2021-10-18","2022-05-13","2022-02-08","2022-02-08","2022-05-13","2022-11-11","2022-11-11","2022-05-13","2021-10-08","2023-03-13","2022-12-28","2022-12-28","2021-06-11","2022-06-08","2022-06-08","2022-06-08","2021-10-08"],"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":[["","68180098103","LISINOPRIL TAB","20MG","30","Select","Select",""],["","65862001705","AMOXICILLIN CAP","500MG","4","Select","Select",""],["","45802086803","POLYETH GLYC POW","3350 NF","510","Select","Select",""],["","68180098103","LISINOPRIL","20 MG","90","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","4","Select","Select",""],["","45802086803","POLYETH GLYC","POW 3350 NF","510","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":""}]}]}