{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" IRRETNAMWOB","gend":1,"add":"RAM 0339EVA WOL","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1961-09-13","age":"","mstatus":"","insh":"18300210*43","cliId":"","pno":"72\/7579743-7","cno":"","email":"","ename":"","eno":"","pphy":"BEVERLY, VERNIS MD","ppno":"757\/623-0095","pcpadd":"SUITE 1 1401 TIDEWATER DR","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":"","pcpname":"Adult and Pediatric Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["K21.9","B20.","E78.5","R42.","R25.2","Z01.419","S63.511A","S63.521A","S60.211A","S60.221A","Z23.","H81.10","H69.80","H60.502","R60.9","G47.00","M79.606","M79.671","M79.672","M76.71","M76.72","M76.821","M76.822","M21.6X1","M21.6X2"],"date":["2022-10-20","2022-10-20","2022-10-20","2020-01-16","2020-03-26","2021-10-26","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2020-10-23","2019-04-28","2019-05-26","2019-02-21","2022-04-28","2022-02-03","2022-05-12","2022-07-20","2022-07-20","2022-07-20","2022-07-20","2022-07-20","2022-07-20","2022-07-20","2022-07-20"],"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":[["","","PRAVASTATIN"," PRAVASTATIN ","30","Select","Select",""],["","","METHOCARBAM"," METHOCARBAM ","60","Select","Select",""],["","68382080505","TRAZODONE","TAB 50MG","30","Select","Select",""],["","16729017401","AMITRIPTYLIN","TAB 75MG","30","Select","Select",""],["","","NAPROXEN"," NAPROXEN ","60","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","61958250101","BIKTARVY","TAB ","30","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","QUETIAPINE"," QUETIAPINE ","45","Select","Select",""],["","","PANTOPRAZOLE"," PANTOPRAZOLE ","30","Select","Select",""],["","","MEGESTROL"," MEGESTROL ","600","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","15","Select","Select",""],["","15584010101","ATRIPLA","TAB ","30","Select","Select",""],["","00093523456","EFAVIR\/EMTRI","TAB TENOFOVI","30","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","","TRIAMCINOLON","OIN 0.005","","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","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":""}]}]}