{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEJA R DAVIS","gend":1,"add":"8270 SHIMMERING ROCK ROAD","city":"GAINESVILLE","state":"VA","zip":"20155-9998","dob":"1990-05-25","age":"","mstatus":"","insh":"20072807*01","cliId":"","pno":7034381703,"cno":7034381703,"email":"","ename":"","eno":"","pphy":"MACKIE-LEE, SUSANNE B MD","ppno":7037536772,"pcpadd":"7500 IRON BAR LN STE 120,","pcpcity":"GAINESVILLE","pcpstate":"VA","pcpzip":"20155-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8889724515,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F16.90","R56.9","F31.32","F43.10","F19.90","F31.9","Z87.898","Z72.0","Z20.828","R55.","M54.2","F17.200","G47.19","F12.20","T50.902A","NO DATA","T50.901A","T14.8XXA","T43.591A","T43.222A","Z03.818"],"date":["2021-06-24","2021-09-07","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2021-10-20","2021-05-11","2021-05-11","2021-05-11","2021-07-30","2021-03-23","2022-07-06","2022-07-07","2021-06-08","2021-07-07","2022-07-04","2022-07-04","2022-07-04"],"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":[["","31722053712","LEVETIRACETA TAB","500MG","30","Select","Select",""],["","66993043385","PRAZOSIN HCL CAP","5MG","30","Select","Select",""],["","70000034802","NICOTINE POL GUM","2MG MINT","200","Select","Select",""],["","00555030202","HYDROXYZ PAM CAP","50MG","30","Select","Select",""],["","69097082312","CITALOPRAM TAB","20MG","30","Select","Select",""],["","31722053712","LEVETIRACETA","TAB 500MG","30","Select","Select",""],["","70000034802","NICOTINE POL","GUM 2MG MINT","200","Select","Select",""],["","00555030202","HYDROXYZ PAM","CAP 50MG","30","Select","Select",""],["","66993043385","PRAZOSIN HCL","CAP 5MG","30","Select","Select",""],["","69097082312","CITALOPRAM","TAB 20MG","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":""}]}]}