{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"H NELREDNOSREDNE","gend":0,"add":" YRD 2964DAOR KROF","city":"DRY FORK","state":"VA","zip":24549,"dob":"1988-02-11","age":"","mstatus":"","insh":"09200210*70","cliId":"","pno":"33\/4349472-4","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"434\/793-0700","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":24549,"pcpcounty":"","pcpid":"","pcpname":"PROVIDENCE FAMILY SPORTS MEDICINE INC","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","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":["E11.3293","H40.013","H52.4","D36.13","L29.8","R20.8","L53.8","D48.5","D23.5","L73.0","L81.6","M72.1","H52.203","E11.9","L90.5","I10.","Z68.41"],"date":["2021-10-06","2021-10-06","2021-10-06","2022-01-21","2021-10-08","2021-10-08","2021-10-08","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2021-09-28","2019-10-08","2022-08-24","2022-01-21","2022-08-24","2022-08-24"],"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":[["","","GLIMEPIRIDE"," GLIMEPIRIDE ","30","Select","Select",""],["","","JANUVIA"," JANUVIA ","30","Select","Select",""],["","","METFORMIN"," METFORMIN ","60","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","","ROSUVASTATIN"," ROSUVASTATIN ","30","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","","FLUZONE","INJ 2020-21","","Select","Select",""],["","49281072110","FLUBLOK","INJ 2021-22","0","Select","Select",""],["","","PNEUMOVAX","INJ 25\/0.5","","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":""}]}]}