{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" P   YBBOBGRUBNERHAW","gend":0,"add":"SAW E 6352TS NOTGNIH","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1979-03-23","age":"","mstatus":"","insh":"74000910*756","cliId":"","pno":"39\/7575141-5","cno":"757\/724-3727","email":"","ename":"","eno":"","pphy":"FLETCHER, HAYLEY NP","ppno":"757\/354-2885","pcpadd":"6160 KEMPSVILLE CIRCLE SUITE 325A","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"MID-ATLANTIC POST ACUTE AND LONG TERM CARE PLLC","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":" ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.0","Z79.899","F20.9","Z51.81","F25.9","J18.9","R07.81","Z20.822","F17.210","E78.5","K59.00","E03.9","E55.9","Z88.8","Z88.0","Z87.891","Z09.","Z87.09","R91.8","Z87.01","J18.1","R68.89","R79.1","R07.9","R05.","J98.4","R93.89","R91.1","E66.9"],"date":["2022-11-04","2022-11-04","2022-10-02","2022-10-02","2022-05-02","2021-09-28","2021-08-22","2021-08-22","2021-08-22","2022-08-30","2022-07-20","2022-08-30","2022-08-30","2021-08-22","2021-08-22","2021-08-22","2022-10-01","2022-10-01","2022-11-04","2021-09-01","2021-09-28","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-09-28","2022-11-04","2022-08-30"],"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":{"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":[["","62756079813","DIVALPROEX SODIUM DR","TAB 500MG DR","62","Select","Select",""],["","00093440401","CLOZAPINE","TAB 50MG","28","Select","Select",""],["","60505257809","ATORVASTATIN CALCIUM","TAB 10MG","31","Select","Select",""],["","69238183107","LEVOTHYROXINE SODIUM","TAB 50MCG","31","Select","Select",""],["","75834002001","VITAMIN D3","CAP 50000UNT","5","Select","Select",""],["","69315013610","BENZTROPINE MESYLATE","TAB 0.5MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","00143314250","DOXYCYCLINE HYCLATE","CAP 100MG","20","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","AER HFA","18","Select","Select",""],["","00904656460","BENZONATATE","CAP 100MG","3","Select","Select",""],["","57896040110","DOCUSATE SODIUM","CAP 100MG","31","Select","Select",""],["","70461032103","FLUCELVAX QUADRIVALENT 2021-2022","INJ 2021-22","0","Select","Select",""],["","00904615760","VITAMIN D","TAB 2000UNIT","31","Select","Select",""],["","40985027416","D3 SUPER STRENGTH","CAP 2000UNIT","28","Select","Select",""],["","49483034001","ACETAMINOPHEN","TAB 325MG","60","Select","Select",""],["","58160089052","FLUARIX QUADRIVALENT 2022-2023","INJ 2022-23","0","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":""}]}]}