{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAVON  D CALLOWAY","gend":1,"add":"1125 KEELING DR","city":"KEELING","state":"VA","zip":"24566-9998","dob":"1985-07-25","age":"","mstatus":"","insh":"8043507*01","cliId":"","pno":4347975843,"cno":4347975843,"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":["F31.9","G43.019","H81.12","G40.201","F32.89","R09.81","B37.3","R53.83","Z20.822","F41.1","G44.201"],"date":["2023-06-28","2023-06-28","2023-06-28","2022-12-28","2021-06-28","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2022-12-28","2023-06-28"],"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":[["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","57237010601","DIVALPROEX","TAB 125MG DR","60","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","30","Select","Select",""],["","69097086107","ZONISAMIDE","100 MG","90","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","00023650110","UBRELVY","100 MG","16","Select","Select",""],["","00002143611","EMGALITY PEN","120 MG\/ML","1","Select","Select",""],["","68180067106","LURASIDONE HCL","40 MG","30","Select","Select",""],["","57237010601","DIVALPROEX SODIUM","125 MG","60","Select","Select",""],["","59267100001","PFIZER VACC INJ COVID-","19","0","Select","Select",""],["","57237010601","DIVALPROEX TAB","125MG DR","60","Select","Select",""],["","63402030430","LATUDA TAB","40MG","30","Select","Select",""],["","00002143611","EMGALITY INJ","120MG\/ML","1","Select","Select",""],["","69097086107","ZONISAMIDE CAP","100MG","90","Select","Select",""],["","00023650110","UBRELVY TAB","100MG","16","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":""}]}]}