{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EINAHPETSORAFOTTO ","gend":1,"add":"IR 191DR REV","city":"NEWPORT NEWS","state":"VA","zip":"23601-9998","dob":"1962-06-21","age":"","mstatus":"","insh":"1020520*09","cliId":"","pno":"17\/7578884-5","cno":"757\/771-4219","email":"","ename":"","eno":"","pphy":"CALE, ALLISON G NP","ppno":"757\/968-5700","pcpadd":"28855 DENBIGH BOULEVARD","pcpcity":"GRAFTON","pcpstate":"VA","pcpzip":"23692","pcpcounty":"","pcpid":"","pcpname":"Patriot Primary Care","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","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":["I10.","E55.9","E03.8","E06.3","M25.561","R07.89","F41.9","D75.839","R00.0","E07.9","Z87.891","Z79.82","Z79.899","D47.3","Z13.29","Z13.21","Z13.228","Z13.0","Z01.419","Z11.51","Z11.3","S83.8X1A","M25.461","R07.9","S76.111A","F41.8","Z13.220","R06.02","D48.5","L57.8","D22.5","L82.1","L57.0","Z23.","Z86.16"],"date":["2022-03-23","2022-03-23","2022-03-23","2022-03-23","2021-09-22","2022-01-15","2022-01-15","2022-01-15","2022-01-15","2022-01-15","2022-01-15","2022-01-15","2022-01-15","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2021-07-19","2021-07-19","2021-07-19","2021-08-11","2021-09-15","2022-01-16","2021-09-21","2022-01-15","2021-03-29","2022-03-24","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-09-07","2021-03-24"],"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":[["","68382014601","RAMIPRIL","CAP 5MG","90","Select","Select",""],["","47781065190","LEVOTHYROXIN","TAB 100MCG","90","Select","Select",""],["","72305010030","EUTHYROX","TAB 100MCG","90","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","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":""}]}]}