{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  AICIRTAPSKRAPS A ","gend":1,"add":"HTRUOC DLO 17541B TINU YAW ESUO","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1981-06-26","age":"","mstatus":"","insh":"1128710*85","cliId":"","pno":"05\/7577376-6","cno":"","email":"","ename":"","eno":"","pphy":"NELSON, ANDREA K NP","ppno":"757\/595-9905","pcpadd":"11842 ROCK LANDING DR. STE 115","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"MAWC - Peninsula Women's Care","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":["Z13.32","Z30.430","Z21.","R87.810","Z23.","M54.89","O60.14X0","O69.81X0","O98.72","Z3A.36","Z37.0","O98.712","Z3A.16","Z79.899","O09.523","O98.719","Z3A.29","Z39.1","Z34.82","Z34.83","Z20.828","Z03.818","Z01.419","Z80.3","O98.711","O09.521","Z3A.13","Z87.891","O99.02","D64.9","O71.82","O99.214","E66.01","R10.2","N89.8","B37.3","J10.89","J20.9"],"date":["2020-11-04","2020-11-04","2020-12-16","2020-04-29","2020-09-08","2020-07-30","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-05-06","2020-05-06","2020-05-06","2020-08-10","2020-08-10","2020-08-10","2020-09-08","2020-09-08","2020-09-08","2021-03-24","2021-03-24","2021-04-08","2021-04-08","2020-04-15","2020-04-15","2020-04-15","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-09-23","2020-07-30","2020-10-14","2020-10-14","2019-02-26","2019-02-17"],"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":[["","","SYMTUZA","TAB ","","Select","Select",""],["","00472016615","NYSTATIN","OIN 100000","15","Select","Select",""],["","61958070101","TRUVADA","TAB 200-300","30","Select","Select",""],["","59676056630","PREZISTA","TAB 800MG","30","Select","Select",""],["","00074333330","NORVIR","TAB 100MG","30","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","DOXYL\/PYRID","TAB 10-10MG","","Select","Select",""],["","65862068730","RITONAVIR","TAB 100MG","30","Select","Select",""],["","","ZIDOVUDINE","SYP 50MG\/5ML","","Select","Select",""],["","00603158758","PROMETH","SOL PLAIN","150","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00603459321","METHYLPRED","TAB 4MG","21","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":""}]}]}