{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CSICNARFSEVEIN O","gend":0,"add":"YLLOJ 4022DAOR DNOP ","city":"WILLIAMSBURG","state":"VA","zip":"23188-7553","dob":"1955-01-19","age":"","mstatus":"","insh":"12010108","cliId":"","pno":"5275773966","cno":7575966010,"email":"","ename":"","eno":"","pphy":"BURTON, JAMEY","ppno":7572208300,"pcpadd":"856 J Clyde Morris Blvd, Ste A","pcpcity":"Newport News","pcpstate":"VA","pcpzip":236011318,"pcpcounty":"","pcpid":"","pcpname":"RIVERSIDE PHYSICIAN SERVICES INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"2204 JOLLY POND ROAD","madd2":"","madd3":"","mcity":"WILLIAMSBURG","mstate":"VA","mzip":"23188-7553","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.9","Z12.11","Z86.010","Z80.0","Z79.899","Z00.00","L20.89","H61.23","R00.1","B37.0","E78.2","Z13.1","E55.9","Z12.5","K08.9","F25.9","F17.210","F20.0","R25.9","Z23","E46","D69.6","E53.8","Z71.6"],"date":["2022-03-31","2020-01-13","2020-01-13","2020-01-13","2021-02-17","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-11-17","2021-03-15","2021-11-17","2021-03-15","2021-03-15","2021-11-17","2021-11-17","2022-03-13","2021-11-17","2021-11-29","2021-11-17","2021-11-17","2021-11-17","2021-11-17"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","65862015901","ZOLPIDEM","TAB 5MG","15","Select","Select",""],["","70954021210","TRIHEXYPHEN","TAB 2MG","15","Select","Select",""],["","00527179101","FLUPHENAZINE","TAB 10MG","45","Select","Select",""],["","67877051310","ATORVASTATIN","CAL CIUM ORAL","90","Select","Select",""],["","00904530780","BANOPHEN","CAP 50MG","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","67877025115","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00904662735","EAR","DRO 0.065","15","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","280","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":""}]}]}