{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M YDNARBEROMELC","gend":1,"add":"XOB OP1986 ","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1979-03-01","age":"","mstatus":"","insh":"4325210*58","cliId":"","pno":"-1699728","cno":"","email":"","ename":"","eno":"","pphy":"POWERS, STEVEN B MD","ppno":"757\/436-0167","pcpadd":"SUITE 200 667 KINGSBOROUGH SQUARE","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"MAWC - TotalCare 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":["F90.2","F90.0","Z00.00","E66.3","F90.9","R53.83","F41.9","Z01.419","Z12.4","Z12.31","Z90.710","F32.9","N76.4","M79.89","NO DATA","K76.0","R68.82","R73.03","M25.512","R11.0","R03.0","R60.9","Z12.72","Z12.39","M75.52","N95.1","E53.8","E55.9","M25.519","B68.9","E11.9","L03.90"],"date":["2021-03-16","2021-04-13","2020-09-29","2021-06-08","2022-10-31","2021-06-08","2022-10-24","2022-10-31","2020-08-03","2020-08-03","2021-09-07","2020-09-01","2020-08-03","2021-04-14","2021-08-12","2022-03-07","2022-02-07","2022-03-07","2020-06-29","2022-07-28","2020-12-03","2020-12-03","2021-09-07","2021-09-07","2022-06-09","2022-06-28","2022-03-07","2022-08-25","2022-04-06","2022-09-26","2022-02-07","2022-10-31"],"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":[["","55111012205","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","62559014901","ESTROG\/MTEST","TAB 1.25-2.5","90","Select","Select",""],["","00555088702","ESTRADIOL","TAB 2MG","90","Select","Select",""],["","00006057761","JANUMET","TAB 50-1000","60","Select","Select",""],["","00555097402","AMPHET\/DEXTR","TAB 30MG","90","Select","Select",""],["","00172392770","DIAZEPAM","TAB 10MG","2","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","16","Select","Select",""],["","00781108901","ALPRAZOLAM","TAB 2MG","90","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","180","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","68382091634","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","57237000630","FLUCONAZOLE","TAB 200MG","14","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","23155005810","GLYBURIDE","TAB 5MG","30","Select","Select",""],["","68308011501","METHAMPHETAM","TAB 5MG","90","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","3","Select","Select",""],["","70436001006","BUPROPN","TAB 150MG XL","90","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","21","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","00472037915","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","90","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}