{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EINNUAIKYELHSA ","gend":1,"add":"TOILLE 62111E TPA TS T","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"2001-10-02","age":"","mstatus":"","insh":"3407710*65","cliId":"","pno":"43\/7572598-3","cno":"","email":"","ename":"","eno":"","pphy":"BONEY, ARON MD","ppno":"757\/278-2240","pcpadd":"155 KINGSLEY LN STE 400","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":"","pcpname":"DEPAUL MEDICAL ASSOCIATES","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":["Z20.828","S39.012A","R10.13","G56.11","M25.521","R11.0","F33.9","N92.1","F60.3","Z68.31","M43.6","J02.9","NO DATA","M25.561","G89.29","Z82.69","Z30.42","E66.01","F43.29","J30.89","Z28.21","Z11.59","Z68.38","F43.21","Z68.39","M54.5","E66.9","Z68.54","Z68.33","S93.402A","Z68.32","Z68.53","R41.840","S33.5XXA"],"date":["2021-09-01","2021-10-24","2021-10-24","2021-04-14","2021-04-14","2021-10-24","2021-12-21","2021-12-21","2020-04-09","2020-01-02","2020-07-15","2020-07-15","2021-12-21","2021-11-02","2021-12-21","2021-11-18","2021-11-18","2021-12-21","2021-11-18","2021-11-18","2021-12-21","2021-12-21","2021-12-21","2021-06-11","2021-06-11","2021-08-30","2021-08-30","2021-08-30","2020-04-09","2019-08-26","2019-10-18","2019-04-26","2019-04-26","2019-06-09"],"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":[["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","","BUPROPION","TAB 150MG SR","","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","90","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","00591333119","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","65862019399","FLUOXETINE","CAP 20MG","30","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":""}]}]}