{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"P   NORAALLESSUR ","gend":0,"add":"PSAJ 559DAOR RE","city":"DUFFIELD","state":"VA","zip":"24244-9998","dob":"2003-09-21","age":"","mstatus":"","insh":"5226110*11","cliId":"","pno":"78\/6721496-0","cno":"276\/219-2072","email":"","ename":"","eno":"","pphy":"POTTER JR, JAMES T MD","ppno":"276\/679-5437","pcpadd":"611 TRENT STREET NE STE A","pcpcity":"NORTON","pcpstate":"VA","pcpzip":24273,"pcpcounty":"","pcpid":"","pcpname":"J T POTTER JR MD PC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","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":["J02.0","J02.9","Z00.121","F41.1","J30.89","R05.","R09.81","Z20.828","R03.0","E66.09","F33.1","Z23.","H10.9","J06.9","T63.441A","Z68.54","Z20.818","U07.1","E66.8","R05.9","I10.","J30.9"],"date":["2020-03-12","2021-06-19","2021-10-15","2021-12-15","2021-06-19","2021-09-23","2021-06-19","2021-09-23","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2019-04-19","2019-12-11","2019-06-10","2019-11-20","2019-10-31","2022-01-31","2022-04-22","2022-01-31","2022-04-22","2022-04-22"],"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":[["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","69230031701","ALLERGY","TAB 10MG","30","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16714089802","LORATADINE","TAB 10MG","14","Select","Select",""],["","00093506201","HYDROXYZ","TAB 50MG","60","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","45802043262","PSEUDOEPHEDR","TAB 30MG","48","Select","Select",""],["","60758018805","GENTAMICIN","SOL 0.3% OP","5","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","51224000160","BENZONATATE","CAP 200MG","20","Select","Select",""],["","64679096405","AZITHROMYCIN","TAB 500MG","5","Select","Select",""],["","00904512546","SUDOGEST","TAB 60MG","24","Select","Select",""],["","42192060704","BROM\/PSE\/DM","SYP ","120","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":""}]}]}