{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YELHSAENIW ","gend":1,"add":"T92 N 74028 TPA TS H","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1990-02-09","age":"","mstatus":"","insh":"4918710*93","cliId":"","pno":"83\/4089101-6","cno":"","email":"","ename":"","eno":"","pphy":"FRANCIS, EVA M NP","ppno":"757\/594-1803","pcpadd":"11803 JEFFERSON AVE STE 140","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"SENTARA MEDICAL GROUP","plan":"OHP","program":"MEDICAID","lob":"M4","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":["F33.1","F33.41","N93.9","M75.42","F31.9","M32.9","J45.909","F17.210","Z79.1","Z79.899","R53.1","R10.2","S00.83XA","R41.82","M54.2","Y04.0XXA","F33.9","K08.9","R53.81","U07.1","N30.00","R50.81","Z20.822"],"date":["2019-05-07","2020-05-30","2021-05-27","2020-02-18","2020-02-18","2020-02-18","2020-02-18","2020-02-18","2020-02-18","2020-02-18","2020-02-18","2021-05-27","2019-02-10","2019-02-10","2019-02-10","2019-02-10","2019-01-15","2021-03-20","2021-03-20","2021-12-23","2021-12-23","2021-12-23","2021-12-23"],"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":[["","","VENLAFAXINE"," VENLAFAXINE ","30","Select","Select",""],["","","FLUCONAZOLE"," FLUCONAZOLE ","1","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","14","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","30","Select","Select",""],["","","SMZ\/TMP"," SMZ\/TMP ","14","Select","Select",""],["","","CEPHALEXIN"," CEPHALEXIN ","10","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","20","Select","Select",""],["","","PAIN"," PAIN ","20","Select","Select",""],["","","TRAMADOL"," TRAMADOL ","6","Select","Select",""],["","","POLYETH"," POLYETH ","510","Select","Select",""],["","","CLINDAMYCIN"," CLINDAMYCIN ","14","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","21","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","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":""}]}]}