{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NYLEUQCAJNAMELOC ","gend":1,"add":"CA 9671TS NRO","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1983-07-07","age":"","mstatus":"","insh":"3023210*74","cliId":"","pno":"09\/7574645-7","cno":"","email":"","ename":"","eno":"","pphy":"ANDERSON, TALISHA D NP","ppno":"757\/744-9044","pcpadd":"1530 BREEZEPORT WAY SUITE 100","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":"","pcpname":"TALISHA ANDERSON","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":["R07.9","I16.0","Z91.14","Z20.828","I10.","I50.9","B35.3","Z23.","Z68.41","M25.569","I42.0","G47.33","E66.01","I16.1","I50.31","R07.89","R42.","I50.22","I50.43","I42.9","D64.9","F41.9","F32.9","Z91.19","F41.8","B34.9","R05.","R68.83","R51.9","Z20.2","M17.0","Z71.6","Z68.42","I43.","I11.0","F17.210","Z79.899","V58.69","R06.02","N89.8","G47.30","I45.4","M75.51","M25.511","G89.29","M22.41","M25.562","M25.561","M22.42","Z68.37","M17.12","M17.11","Z87.891","D64.89","R63.2"],"date":["2021-12-08","2020-08-27","2020-08-28","2020-12-10","2021-12-08","2021-06-09","2020-09-29","2020-09-29","2021-11-15","2020-09-29","2021-10-05","2021-10-05","2021-10-05","2020-08-28","2020-08-27","2021-12-08","2021-12-08","2020-08-25","2020-08-28","2020-08-28","2020-08-28","2020-08-27","2020-08-27","2020-08-27","2021-06-09","2020-12-10","2020-12-10","2020-12-10","2020-12-10","2020-12-29","2021-11-15","2021-06-09","2021-06-09","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-25","2020-08-27","2020-12-10","2021-11-16","2020-08-25","2021-11-15","2021-11-15","2021-11-15","2019-05-30","2019-08-01","2019-08-01","2019-05-30","2019-06-27","2019-08-01","2019-08-01","2019-04-15","2019-04-15","2019-04-15"],"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":[["","69097083305","SERTRALINE","TAB 25MG","30","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","76385011150","CARVEDILOL","TAB 6.25MG","60","Select","Select",""],["","00536110788","NICOTINE","DIS 14MG\/24H","30","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","","AMLODIPINE","TAB 10MG","","Select","Select",""],["","","ISOSORB","TAB 60MG ER","","Select","Select",""],["","16252051605","CIPROFLOXACN","TAB 750MG","20","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","68180016106","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","","CLOTRIMAZOLE","CRE 0.01","","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","270","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","00245010810","FERROUS","TAB 325MG EC","30","Select","Select",""],["","43386035701","HYDROCO\/APAP","TAB 7.5-325","12","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":""}]}]}