{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YCNANSSOR ","gend":1,"add":"IALB 6301RD EROMR","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1971-11-02","age":"","mstatus":"","insh":"3033210*82","cliId":"","pno":"86\/7575440-9","cno":"","email":"","ename":"","eno":"","pphy":"MOSIER, KRISTEN A MD","ppno":"757\/793-4710","pcpadd":"850 KEMPSVILLE RD SUITE 100A","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"MAWC - Womancare Centers, PLC","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","J01.90","J02.9","J04.0","R05.","A49.02","B35.1","Z12.11","K63.5","R00.2","H01.024","H11.012","H53.19","J20.9","H90.5","Z87.898","D64.9","K21.9","I50.9","Z76.89","Z68.26","Z01.419","N93.9","N94.6","R21.","R53.83","Z32.02","N95.9","N84.0","Z98.891","Z72.0","D50.9","H90.0"],"date":["2020-11-02","2021-04-18","2021-04-18","2021-04-18","2021-04-18","2021-05-13","2021-05-13","2020-11-04","2020-11-04","2021-07-29","2021-03-22","2021-03-22","2021-03-22","2021-04-07","2021-07-26","2021-07-26","2020-11-04","2020-11-04","2021-05-06","2021-05-06","2021-05-06","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2021-06-04"],"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":[["","57237000511","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","53489012002","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","14","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","62332025050","DOXYCYC","CAP 100MG","28","Select","Select",""],["","05928000100","SINUS","POW KIT","50","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":""}]}]}