{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NAGIA KELLY-HOLLAND","gend":1,"add":"513 CHATHAM AVE APT 4","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"2003-04-04","age":"","mstatus":"","insh":"20030542*01","cliId":"","pno":4342289262,"cno":4342289262,"email":"","ename":"","eno":"","pphy":"KHAN, SALMA Z DO","ppno":4348573600,"pcpadd":"414 PARK AVE,","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":"24541-9998","pcpcounty":"","pcpid":"","pcpname":"GoDocs","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4348573601,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H93.292","F43.10","F91.9","F20.0","F33.1","H65.03","R09.81","R07.0","NO DATA","M79.606","M54.9","Z53.20","V62.84","F33.2","F43.12","Z20.822","R03.0","M79.601","M79.602","R11.0","H93.12","Z01.10","H18.821","N76.0","B00.1","N89.8","Z11.3","Z30.011","E66.01","Z32.02","A64.","E78.5","E55.9"],"date":["2021-07-08","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2021-11-15","2021-10-24","2021-10-24","2022-11-21","2022-11-21","2022-11-21","2022-11-21","2022-02-18","2021-11-19","2021-11-12","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2021-07-08","2021-07-08","2023-03-02","2023-09-02","2023-09-02","2023-09-02","2023-08-02","2023-08-02","2023-08-31","2023-08-02","2023-08-31","2023-08-31","2023-08-31"],"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":[["","00378110110","PRAZOSIN HCL","CAP 1MG","90","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","49884040191","RISPERIDONE","TAB 2MG ODT","30","Select","Select",""],["","63402030630","LATUDA","TAB 60MG","30","Select","Select",""],["","24208083060","NEOMYCIN-POLYMYXIN-DEXAMETH","0.1 %","5","Select","Select",""],["","13668001005","CITALOPRAM TAB","20MG","30","Select","Select",""],["","00378110110","PRAZOSIN HCL CAP","1MG","90","Select","Select",""],["","63402030630","LATUDA TAB","60MG","30","Select","Select",""],["","49884040191","RISPERIDONE TAB","2MG ODT","30","Select","Select",""],["","53489011905","DOXYCYCLINE HYCLATE","100 MG","14","Select","Select",""],["","00555902858","JUNEL FE","1.5-30(21)","28","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","13","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE","150 MG","1","Select","Select",""],["","31722070530","VALACYCLOVIR","1000 MG","21","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":""}]}]}