{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S YRAMTRAWET","gend":1,"add":"ECNIRP 1012TC ENNA SS","city":"VIRGINIA BEACH","state":"VA","zip":"23457-9998","dob":"1974-10-16","age":"","mstatus":"","insh":"7178120*85","cliId":"","pno":"5775738012","cno":7577521083,"email":"","ename":"","eno":"","pphy":"FONTANARES, ARLENE MD","ppno":7574613890,"pcpadd":"STE 208 844 KEMPSVILLE RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23502-9998","pcpcounty":"","pcpid":"","pcpname":"MAWC - Tidewater Physicians for Women","plan":"OHP","program":"ACA","lob":"Individual","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":["R18.8","R06.02","R17.","R19.00","R07.9","K70.30","D50.9","L65.0","L82.1","L85.1","Z71.9","K74.60","I85.10","K76.6","K31.89","K57.10","F10.10","D64.9","F41.9","Z88.5","Z79.82","Z79.899","R11.2","K70.31","R14.0","Z01.419","Z12.31","Z12.12","Z12.4","N95.2","N95.1","L65.9","E03.9","I34.89","K21.9","R53.83","R93.3","F10.232","F10.20","K70.11","R60.0","Z88.8","M79.89","R11.0","J40.","D72.818","I85.00","K31.4","R10.84","R10.9","Z12.11","R10.13","K42.9","F10.239","I34.1","G47.00","Z91.411","F17.210"],"date":["2022-11-10","2022-07-22","2022-07-21","2022-07-02","2022-07-06","2023-01-21","2022-09-15","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2022-07-22","2022-07-12","2022-07-12","2022-07-12","2022-09-27","2022-07-22","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2022-10-05","2023-01-22","2023-01-22","2023-01-22","2023-01-22","2022-07-21","2023-01-21","2023-01-31","2022-07-06","2023-01-21","2022-07-06","2022-07-02","2022-07-06","2023-03-18","2023-03-18","2022-11-10","2022-07-12","2022-07-25","2022-07-06","2022-11-10","2022-07-12","2022-09-27","2023-01-21","2023-01-21","2023-01-21","2023-01-21","2023-01-21"],"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":[]},{"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":""}]}]}