{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ASSILEMYELTNUH L","gend":1,"add":"IEL E 112TS RETSEC","city":"WINCHESTER","state":"VA","zip":"22601-9998","dob":"1985-04-09","age":"","mstatus":"","insh":"2122210*00","cliId":"","pno":"26\/0451929-4","cno":"","email":"","ename":"","eno":"","pphy":"OGBONLOWO, OLUFUNMILOLA MD","ppno":"540\/536-5400","pcpadd":"1440 AMHERST STREET","pcpcity":"WINCHESTER","pcpstate":"VA","pcpzip":22601,"pcpcounty":"","pcpid":"","pcpname":"VALLEY PHYSICIAN ENTERPRISE INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.20","J01.00","J06.9","Z11.52","F15.21","F33.0","F10.21","M65.319","M19.042","M25.532","F11.20","F15.10","Z01.419","M65.312","Z00.00","Z13.220","Z20.822"],"date":["2021-02-22","2021-02-27","2021-09-03","2021-02-27","2021-05-03","2021-08-23","2021-12-10","2021-12-09","2021-12-09","2021-12-09","2020-06-29","2020-06-29","2021-03-22","2021-11-17","2020-08-05","2020-08-05","2021-09-03"],"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":[["","","BUPROPION"," BUPROPION ","90","Select","Select",""],["","","ELURYNG","MIS ","","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","Select","Select",""],["","","AMOX\/K"," AMOX\/K ","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","21","Select","Select",""],["","","SPRINTEC"," SPRINTEC ","28","Select","Select",""],["","","ETONOGESTERE","MIS ETHY EST","","Select","Select",""],["","","ETONOGESTREL","MIS ETHY EST","","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","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":""}]}]}