{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHONICE  L BROGGIN","gend":1,"add":"1370 MUD ST COURT ST P O BOX 549","city":"CONCORD","state":"VA","zip":"24538-9998","dob":"1990-07-12","age":"","mstatus":"","insh":"9692088*01","cliId":"","pno":4342158387,"cno":4342158387,"email":"","ename":"","eno":"","pphy":"PHILLIPS, JESSICA NP","ppno":4349291400,"pcpadd":"134 ELON RD,","pcpcity":"MADISON HEIGHTS","pcpstate":"VA","pcpzip":"24572-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4349290410,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R52.","R55.","R51.9","R42.","W19.XXXA","J01.90","B96.89","F17.200","G44.209","L43.9","R21.","D49.2","M79.89","R10.31","R10.32","T67.1XXA","F17.210","Z20.822","J06.9","R07.9","R07.89","E86.0","R53.1","Z30.9","Z13.89","Z30.42"],"date":["2021-07-15","2021-10-03","2021-07-15","2021-07-15","2021-07-15","2021-12-22","2021-12-22","2021-12-22","2021-12-22","2022-09-19","2022-09-19","2022-09-19","2022-07-14","2022-10-28","2021-04-13","2021-07-15","2021-07-15","2021-10-08","2021-10-08","2021-10-03","2021-10-03","2021-10-03","2021-10-03","2023-06-05","2023-06-05","2023-06-05"],"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":[["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00093026292","FLUOCINONIDE","CRE 0.0005","60","Select","Select",""],["","16571040250","CETIRIZINE TAB","10MG","90","Select","Select",""],["","68180012202","CEPHALEXIN CAP","500MG","20","Select","Select",""],["","00093101042","MUPIROCIN OIN","2%","22","Select","Select",""],["","00093026492","FLUOCINONIDE OIN","0.05%","60","Select","Select",""],["","00093026292","FLUOCINONIDE CRE","0.05%","60","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":""}]}]}