{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EUQINIMODSNIKPOH ","gend":0,"add":"   TRUOC MAHGNIKCUB N 038                         ","city":"VIGINIA BEACH            ","state":"VA","zip":"23462-1007","dob":"1999-02-07","age":"","mstatus":"","insh":"20117500","cliId":"","pno":"5475746696","cno":7576469028,"email":"","ename":"","eno":"","pphy":"HAMBAZ, NASSER","ppno":7576717777,"pcpadd":"4876 BAXTER RD,","pcpcity":"Virginia Beach","pcpstate":"VA","pcpzip":234624404,"pcpcounty":"","pcpid":"","pcpname":"FIRST CHOICE MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"830 N BUCKINGHAM COURT                            ","madd2":"                                                  ","madd3":"","mcity":"VIGINIA BEACH            ","mstate":"VA","mzip":"23462-1007","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.9","F94.0","F70","Z63.4","F84.0","R30.0","E78.5","F20.0"," ","F45.8","J45.909","R73.03","Z00.01","R56.9","R41.841","Z00.00"],"date":["2022-12-09","2022-12-09","2022-12-09","2022-12-09","2022-12-09","2022-10-24","2022-11-09","2022-10-24","2022-12-09","2022-11-09","2022-11-09","2022-11-09","2022-11-09","2022-11-09","2022-11-09","2022-11-09"],"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":[["","70069038305","HALOPER","INJ 100MG\/ML","2","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","60","Select","Select",""],["","69238207801","PROPRANOLOL","TAB 20MG","90","Select","Select",""],["","57664024188","CLOZAPINE","TAB 50MG","30","Select","Select",""],["","00093342605","LORAZEPAM","TAB 1MG","90","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0.25","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":""}]}]}