{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EPOL M   SIULTRUOCNATEB Z","gend":0,"add":"LOC 068RD NEEL","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1942-06-21","age":"","mstatus":"","insh":"49300210*24","cliId":"","pno":"78\/7573496-2","cno":"","email":"","ename":"","eno":"","pphy":"SOTO GUERRERO, YAZMIN MD","ppno":"757\/877-1529","pcpadd":"SUITE 7B 710 DENBIGH BLVD","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23608,"pcpcounty":"","pcpid":"","pcpname":"RIVERA-SOTO MEDICAL GROUP INTERNAL MEDICINE SPECIALISTS LLC","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F79.","F43.20","F03.90","I50.9","E78.5","I34.0","I25.10","NO DATA","R19.7","R60.0","T50.905A","I34.1","I10.","E88.09","R79.89","E78.1","R73.9","E55.9","Z13.0","R94.39"],"date":["2020-11-09","2020-05-12","2021-11-16","2021-11-16","2021-11-16","2021-08-19","2021-08-19","2021-11-16","2020-07-03","2021-02-25","2020-07-03","2021-08-19","2021-08-19","2021-05-18","2021-02-25","2020-05-14","2021-08-18","2021-08-25","2019-03-18","2019-06-06"],"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":[["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","","CARVEDILOL","TAB 3.125MG","","Select","Select",""],["","","RA"," RA ","30","Select","Select",""],["","","QUETIAPINE","TAB 25MG","","Select","Select",""],["","00904679480","ASPIRIN","CHW 81MG","30","Select","Select",""],["","","ISOSORB"," ISOSORB ","135","Select","Select",""],["","12843010105","BAYER","CHW 81MG","36","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","90","Select","Select",""],["","","HYDROCHLOROT"," HYDROCHLOROT ","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","","DONEPEZIL","TAB 5MG","","Select","Select",""],["","","METOPROL","TAB 25MG ER","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","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":""}]}]}