{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDREW F KLECAR","gend":0,"add":"1511 FOREST RUN DR APT C","city":"HENRICO","state":"VA","zip":"23228-9998","dob":"1991-12-26","age":"","mstatus":"","insh":"20080454*01","cliId":"","pno":5406143124,"cno":5406143124,"email":"","ename":"","eno":"","pphy":"DEVINCENTIS, CHRISTINA M MD","ppno":5408256263,"pcpadd":"16268 BENNETT RD,","pcpcity":"CULPEPER","pcpstate":"VA","pcpzip":"22701-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5408254911,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","L03.113","F43.10","F33.1","L02.414","L03.114","L02.91","F19.10","B18.2","F14.20","L02.412","M79.631","R60.0","T14.90XA","Z45.2","A41.9","R94.5","K76.9","D50.0","K90.89","Z91.89","Z86.19","L02.413","W46.1XXA","Z98.890","B19.20","B95.4","Z68.30","E66.9","Z86.14","Z88.1","Z91.040"],"date":["2022-11-01","2022-04-16","2022-02-24","2022-02-24","2022-08-01","2022-08-02","2022-08-02","2022-08-02","2022-08-02","2022-11-01","2022-07-30","2022-07-30","2022-07-30","2022-07-30","2022-07-30","2022-07-30","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-07-30","2022-04-17","2022-04-17","2022-04-17","2022-07-30","2022-07-30","2022-07-30","2022-07-30","2022-07-30","2022-07-30","2022-07-30"],"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":[["","70010008501","PRAZOSIN HCL","CAP 2MG","7","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","11","Select","Select",""],["","57237017501","VENLAFAXINE","TAB 75MG","30","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","00591081083","SILVER SULFA","CRE 0.01","25","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","43598021025","SSD","CRE 0.01","25","Select","Select",""],["","65862019301","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","00054018913","BUPREN\/NALOX","SUB 8-2MG","11","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","65862001105","SERTRALINE","TAB 25MG","30","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","50580034401","TYLENOL COLD","TAB DAY","48","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","20","Select","Select",""],["","00093005405","BUSPIRONE HCL","10 MG","60","Select","Select",""],["","42571016242","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","67877032005","IBUPROFEN","600 MG","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":""}]}]}