{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ENYAWDDIER ","gend":0,"add":"ESNAN 0802YWKP DNOM","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1977-02-13","age":"","mstatus":"","insh":"47600210*76","cliId":"","pno":"07\/7578071-8","cno":"757\/708-1708","email":"","ename":"","eno":"","pphy":"PAGTAKHAN, GRACE NP","ppno":"757\/484-7248","pcpadd":"2897 BRIDGE RD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":"","pcpname":"NANSEMOND SUFFOLK FAMILY PRACTICE","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["G35.","R39.81","L22.","G82.50","U07.1","R33.9","R07.9","D72.819","D89.9","G31.84","N31.9","G80.0","E55.9","D64.9","Z99.3","H25.11","R26.2","E63.9","E78.00","K59.00","Z11.59","Z13.220","Z74.09","R29.898","Z02.89","R53.1","M62.838","M35.9","F43.20","R26.81","E78.5","Z12.11","Z71.2","R52.","M62.81","R50.9"],"date":["2022-11-20","2022-09-28","2022-09-28","2022-10-19","2022-01-04","2021-12-31","2021-12-31","2022-10-19","2022-10-19","2022-10-19","2022-10-19","2022-05-24","2022-10-19","2022-05-24","2022-05-24","2022-07-11","2022-11-16","2020-08-03","2020-08-03","2020-08-03","2021-12-08","2021-12-08","2022-02-22","2021-12-08","2021-12-08","2022-01-04","2020-10-24","2021-04-09","2020-07-02","2021-09-28","2022-04-05","2022-04-05","2022-04-05","2022-01-04","2021-10-04","2022-01-04"],"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":[["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","00832105515","BACLOFEN","TAB 20MG","90","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","90","Select","Select",""],["","50428264783","STOOL","CAP 100MG","90","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","90","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","14","Select","Select",""],["","64406000602","TECFIDERA","CAP 240MG","60","Select","Select",""],["","53746054401","PRIMIDONE","TAB 50MG","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":""}]}]}