{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NODNARBTTOCSERP L","gend":0,"add":"ROEG TNIAS 321201 TPA YAW EG","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"2002-07-13","age":"","mstatus":"","insh":"53300210*19","cliId":"","pno":"59\/7572105-2","cno":"","email":"","ename":"","eno":"","pphy":"WENG, JESSICA MD","ppno":"757\/850-1311","pcpadd":"19D FOX HILL RD","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23669,"pcpcounty":"","pcpid":"","pcpname":"RIVERSIDE PHYSICIAN SERVICES INC","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":["NO DATA","Q21.0","J18.9","G47.33","Q90.9","F79.","Z87.74","Z77.22","Z86.79","Z99.89","G40.909","F71.","G40.309","Z00.129","Z13.89","Z11.3","L85.3","K59.00","J30.9","B30.9","J02.8","B97.89","B07.0","L98.9","R22.43","Z20.822","Z91.89","R55.","R51.9","M54.2","Z79.51","Z79.899","H61.22","Q90.0","N28.81","Z90.5","F70.","F98.4","H92.09","Z23.","H61.21","G47.30","R25.9"],"date":["2021-10-07","2021-01-07","2020-01-09","2021-01-25","2021-10-07","2020-01-09","2020-01-09","2020-01-09","2019-02-05","2019-02-05","2021-04-08","2021-08-30","2021-08-30","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-05-03","2019-08-18","2020-10-17","2020-10-17","2020-12-12","2020-12-12","2020-12-12","2021-04-28","2021-04-28","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2021-05-06","2020-03-04","2020-03-04","2021-04-08","2020-05-27","2019-08-18","2021-09-28","2021-09-28","2019-02-05","2019-11-07"],"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":[["","11822334910","RA","DRO 6.5% OT","15","Select","Select",""],["","","AMOXICILLIN","SUS 400\/5ML","","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","","LEVETIRACETA"," LEVETIRACETA ","420","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":""}]}]}