{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"OR REDNAXELAZITRO-ORELB","gend":0,"add":"OB OP402 X","city":"MAPPSVILLE","state":"VA","zip":"23407-9998","dob":"2003-11-18","age":"","mstatus":"","insh":"0051910*46","cliId":"","pno":"66\/7574236-5","cno":"","email":"","ename":"","eno":"","pphy":"BALMORIA, SANDRA MD","ppno":"757\/824-5676","pcpadd":"5219 LANKFORD HIGHWAY","pcpcity":"NEW CHURCH","pcpstate":"VA","pcpzip":23415,"pcpcounty":"","pcpid":"","pcpname":"EASTERN SHORE RURAL HEALTH SYSTEM INC","plan":"OHP","program":"MEDICAID","lob":"M4","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":["K51.80","R70.0","R79.82","R19.5","S00.202A","R63.4","R53.83","R17.","K52.9","NO DATA","K63.89","D64.9","E55.9","R63.5","K51.90","R23.1","J06.9","B97.29","Z91.14","Z91.19","Z23.","Z79.899","Z13.31","D63.8"],"date":["2021-03-30","2021-03-30","2021-03-30","2021-03-30","2020-02-19","2021-02-23","2021-02-23","2021-02-23","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-04-05","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-23","2021-03-11","2019-07-01","2019-01-03","2019-01-03"],"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":[["","50428166363","BISACODYL","TAB 5MG EC","6","Select","Select",""],["","80681007600","MULTIVITAMIN","TAB ","30","Select","Select",""],["","50428035980","CVS","TAB 325MG","30","Select","Select",""],["","80681005000","DAILY-VITE","TAB ","30","Select","Select",""],["","","MESALAMINE","CAP 0.375GM","","Select","Select",""],["","43386031214","GAVILAX","POW ","510","Select","Select",""],["","00054458111","MERCAPTOPUR","TAB 50MG","56","Select","Select",""],["","","ERYTHROMYCIN","OIN OP","","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","30","Select","Select",""],["","65649010302","APRISO","CAP 0.375GM","120","Select","Select",""],["","07610017840","VITAMIN","TAB 5000UNIT","30","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":""}]}]}