{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AIVEATNAHSNERRAW N  ","gend":1,"add":"LIW 2122DAOR YOR","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"2001-11-06","age":"","mstatus":"","insh":"3623710*87","cliId":"","pno":"32\/7576184-7","cno":"","email":"","ename":"","eno":"","pphy":"KING, AMY P NP","ppno":"757\/539-3911","pcpadd":"2050 HILLPOINT BLVD N","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":"","pcpname":"MAWC - Specialists for Women","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":["F32.0","N76.0","Z20.2","N39.0","R31.9","Z30.011","Z11.3","Z11.4","Z72.51","Z00.129","Z68.52","Z23.","Z13.31","Z71.3","Z71.82","L23.0","L42."],"date":["2021-01-15","2020-08-15","2020-08-15","2020-09-23","2020-09-23","2020-04-09","2019-08-11","2019-08-11","2019-08-11","2019-06-21","2019-06-21","2019-06-21","2019-06-21","2019-06-21","2019-06-21","2019-09-18","2019-10-01"],"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":[["","16714040604","LARIN","TAB 44581","28","Select","Select",""],["","00378728353","NORETH\/ETHIN","TAB FE 1\/20","28","Select","Select",""],["","","LIDOCAINE","CRE 0.04","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","VALACYCLOVIR","TAB 1GM","","Select","Select",""],["","","CEFIXIME","CAP 400MG","","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","31722077701","ACYCLOVIR","TAB 400MG","21","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","68180091113","MIBELAS","CHW FE","28","Select","Select",""],["","00023586230","TAYTULLA","CAP 1MG\/20MC","28","Select","Select",""],["","00555902658","JUNEL","TAB 44581","28","Select","Select",""],["","43386009663","CLOBETASOL","OIN 0.0005","45","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","69238103107","MELODETTA","CHW 24 FE","28","Select","Select",""],["","00430054050","MINASTRIN","CHW FE","28","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":""}]}]}