{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIA AANASHALLEDBA ","gend":1,"add":"H 6238RD TLO","city":"HENRICO","state":"VA","zip":"23228-9998","dob":"1986-01-17","age":"","mstatus":"","insh":"5818110*29","cliId":"","pno":"55\/4086607-1","cno":"","email":"","ename":"","eno":"","pphy":"ITSKOVICH, ROZANA A MD","ppno":"804\/364-8802","pcpadd":"STE 204 7660 E PARHAM RD","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23294,"pcpcounty":"","pcpid":"","pcpname":"HEALTHWEST P C","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z34.90","O80.","K02.9","Z11.59","D64.9","Z33.1","Z23.","Z3A.28","O99.62","U07.1","Z37.0","O98.53","Z3A.39","K21.9","O76.","O69.81X0","O77.0","O70.9","Z34.83","R21.","O99.011","E61.1","Z3A.00","O36.8330","O69.81X3","O99.613","O98.513"],"date":["2021-11-18","2021-12-19","2020-08-15","2020-08-15","2021-05-11","2021-10-05","2021-10-05","2021-10-05","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2021-12-19","2020-07-24","2021-05-11","2021-05-11","2021-05-11","2021-12-19","2021-12-19","2021-12-19","2021-12-19"],"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":[["","00904759180","FEROSUL","TAB 325MG","180","Select","Select",""],["","00536440601","VITAMIN","TAB 25MG","90","Select","Select",""],["","00113044164","SLEEP","TAB 25MG","60","Select","Select",""],["","00245010801","FERROUS","TAB 325MG EC","30","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","65862085999","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","30142040378","PAIN","TAB 325MG","30","Select","Select",""],["","68462030529","NORETHINDRON","TAB 0.35MG","28","Select","Select",""],["","42291055384","NORGEST\/ETHI","TAB 0.25\/35","28","Select","Select",""],["","00904672580","SENNA","TAB 8.6MG","20","Select","Select",""],["","68180087773","JENCYCLA","TAB 0.35MG","28","Select","Select",""],["","","MUPIROCIN","OIN 0.02","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","ACETAMIN","TAB 325MG","","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","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":""}]}]}