{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B AIROLGNAMKOOR","gend":1,"add":"P NOTDYOB 1290263 TOL DR KNAL","city":"MCKENNEY","state":"VA","zip":"23872-9998","dob":"1989-03-05","age":"","mstatus":"","insh":"1613210*64","cliId":"","pno":"13\/4088031-2","cno":"","email":"","ename":"","eno":"","pphy":"HERRERA, JOLANTA A MD","ppno":"804\/526-7990","pcpadd":"2552 ALDRIDGE AVE","pcpcity":"SOUTH CHESTERFIELD","pcpstate":"VA","pcpzip":23834,"pcpcounty":"","pcpid":"","pcpname":"JOLANTA A HERRERA MD PLLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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":["R45.4","F41.9","K04.7","F43.24","F39.","E78.5","Z00.01","J45.20","R11.0","F90.0","F10.20","R56.9","F31.60","F12.10","K21.9","J02.9","K08.89","G89.29","F17.210","J31.1","M79.643"],"date":["2020-08-20","2020-09-09","2020-08-20","2020-11-05","2020-10-02","2021-01-29","2021-12-15","2021-12-15","2020-12-02","2021-06-07","2021-09-07","2021-09-21","2021-06-07","2020-11-05","2020-09-09","2021-06-07","2020-10-12","2020-10-12","2020-10-12","2021-03-23","2021-03-23"],"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":[["","","OLANZAPINE","TAB 10MG","","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","PROMETHAZINE","SYP 6.25\/5ML","","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","67877025001","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","60505328006","LEVETIRACETA","TAB 500MG ER","60","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","","METHYLPHENID","TAB 10MG","","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","20","Select","Select",""],["","","ALPRAZOLAM","TAB 1MG","","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","90","Select","Select",""],["","00536116361","MUCUS","TAB 600MG ER","20","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","51224000160","BENZONATATE","CAP 200MG","30","Select","Select",""],["","57237009960","CEFDINIR","CAP 300MG","14","Select","Select",""],["","29300024505","BUSPIRONE","TAB 10MG","180","Select","Select",""],["","","ALBUTEROL","NEB 0.63MG\/3","","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","","VENLAFAXINE","TAB 225MG ER","","Select","Select",""],["","","HYDROXYZ","TAB 50MG","","Select","Select",""],["","","AMOXICILLIN","TAB 500MG","","Select","Select",""],["","","NABUMETONE","TAB 750MG","","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":""}]}]}