{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AYOTALNOMAEB M","gend":1,"add":"TS 7252TS EWO","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1993-05-22","age":"","mstatus":"","insh":"3594210*86","cliId":"","pno":"49\/7571251-9","cno":"757\/366-0116","email":"","ename":"","eno":"","pphy":"NDIRANGU, MAGDALINE W MD","ppno":"757\/436-7888","pcpadd":"675 N BATTLEFIELD BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"Battlefield 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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","N92.1","G43.009","G25.0","R25.2","F41.9","Z33.1","F17.210","Z13.31","Z00.00","N39.0","R11.2","R10.84","N91.1","Z34.91","O20.8","Z3A.12","O88.212","I26.99","R07.9","Z3A.00","B35.4","Z86.711","Z87.891","L98.9","Z71.2","R07.81","M54.42","G89.29","O26.891","N93.9","J10.1","NO DATA","O20.0","J11.1","R10.31","R07.89","V23.9","O88.219","V23.41","Z3A.18","O26.892","U07.1","Z3A.24","V23.89","O88.213","N89.8","Z3A.38","Z39.2","Z32.00","N91.2","Z20.2","R06.02","Z23.","O76.","O26.893","O99.214","Z20.828","Z37.0","Z3A.40","Z91.018","Z34.90","Z87.898","Z87.42","R05.","R68.83","R07.82","S29.9XXA","Z09.","V89.2XXA","Z34.92","Z3A.21","M54.6","M54.5","O98.512","Z79.01","J98.8","O99.512","R50.9","G89.18","B37.2","R25.1","S40.021A","R87.810","R87.610","D25.9","Z01.419","B95.2","Z32.01","Z11.3","V23.5","Z3A.29","Z3A.37","Z3A.08","Z3A.14","R10.30","R30.0","N30.90","I49.9","I49.1","O32.2XX0","Z12.4","R10.9","N87.0","G43.909","Z04.1","Z3A.15","M79.89"],"date":["2021-07-23","2021-05-11","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2019-04-17","2019-08-31","2020-01-30","2019-08-31","2020-01-16","2020-02-14","2020-02-03","2020-02-03","2020-04-02","2020-04-02","2020-04-29","2020-04-02","2019-09-20","2020-08-16","2019-09-20","2019-09-20","2019-10-28","2019-10-02","2019-10-28","2019-10-28","2020-01-30","2019-12-16","2019-12-12","2019-12-12","2019-12-16","2019-12-16","2020-01-30","2020-01-30","2021-11-24","2021-11-24","2020-04-07","2020-03-20","2020-04-29","2020-06-04","2020-04-30","2021-11-24","2020-08-05","2020-08-05","2020-08-05","2020-09-29","2021-09-14","2021-09-14","2019-09-23","2019-12-23","2021-10-15","2020-08-16","2020-08-16","2020-08-16","2020-08-16","2020-08-16","2020-08-16","2020-08-16","2020-08-18","2019-09-04","2019-11-13","2019-12-12","2019-12-12","2020-02-28","2020-02-28","2020-03-06","2020-03-06","2020-03-17","2020-04-07","2019-01-28","2019-01-28","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-04-30","2020-08-17","2021-05-11","2021-07-22","2021-07-22","2019-07-03","2019-07-03","2019-06-19","2021-03-02","2019-06-19","2020-01-16","2020-01-16","2020-06-04","2020-06-04","2020-07-27","2021-10-15","2021-11-24","2020-08-23","2019-01-04","2019-01-04","2019-12-23","2020-01-30","2020-08-16","2021-03-02","2019-05-24","2019-07-17","2019-08-05","2020-02-28","2020-02-28","2020-08-23"],"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":[["","","NORETHINDRON","TAB 0.35MG","","Select","Select",""],["","59779046708","ASPIRIN","CHW 81MG","60","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","ENOXAPARIN","INJ 40\/0.4ML","","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","60","Select","Select",""],["","","VITAMIN","TAB 25MG","","Select","Select",""],["","42806015905","HYDROXYZ","TAB 10MG","30","Select","Select",""],["","69097012303","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","","D3","TAB 2000UNIT","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","PRENATAL","TAB LOW IRON","","Select","Select",""],["","","FERROUS","TAB 325MG","","Select","Select",""],["","","FEROSUL","TAB 325MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","CVS","TAB 325MG","","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","Select","Select",""],["","","SLEEP-AID","TAB 25MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","DOCUSATE","CAP 100MG","","Select","Select",""],["","","DOK","CAP 100MG","","Select","Select",""],["","","CALCIUM","TAB 600MG","","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":""}]}]}