{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ECIDNACNEERG ","gend":1,"add":"EERGWODAEM 5314CM1314 TPA TC N","city":"HENRICO","state":"VA","zip":"23294-9998","dob":"1982-05-08","age":"","mstatus":"","insh":"36500210*89","cliId":"","pno":"39\/4083414-9","cno":"804\/939-4143","email":"","ename":"","eno":"","pphy":"ERSKINE, ANGELA NP","ppno":"804\/560-8921","pcpadd":"9000 STONY POINT PKWY","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23235,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","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":["R07.89","I47.1","Z87.891","Z3A.27","I49.9","O47.9","Z3A.32","O60.03","O26.86","Z3A.34","Z32.01","F32.9","O99.512","O09.522","V23.5","Z3A.26","O62.3","O70.0","Z3A.38","Z37.0"],"date":["2022-04-19","2022-05-26","2022-04-19","2022-04-19","2022-04-19","2022-05-17","2022-05-23","2022-05-23","2022-06-03","2022-06-03","2020-01-24","2020-01-24","2022-04-19","2022-04-19","2022-04-19","2022-04-08","2022-07-03","2022-07-03","2022-07-03","2022-07-03"],"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":[]},{"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":[["","00228306111","AMPHET\/DEXTR","CAP 30MG ER","30","Select","Select",""],["","54092039101","ADDERALL","CAP 30MG","30","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","59310030480","QVAR","AER 80MCG","11","Select","Select",""],["","70700010915","CLOBETASOL","CRE 0.0005","15","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","14","Select","Select",""],["","50458058501","CONCERTA","TAB 18MG","30","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00186091706","PULMICORT","INH 90MCG","1","Select","Select",""],["","00456430001","MONUROL","PAK GRANULES","1","Select","Select",""],["","53885000810","ONETOUCH","MIS PLUS 33G","100","Select","Select",""],["","38396030576","CVS","MIS 30G","100","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":""}]}]}