{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YNOHTNANOSNHOJ","gend":0,"add":"OMYALC 9078C TPA RD TN","city":"HENRICO","state":"VA","zip":23229,"dob":"1987-07-13","age":"","mstatus":"","insh":"6013210*48","cliId":"","pno":"18\/4088739-9","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"804\/655-2794","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23229,"pcpcounty":"","pcpid":"","pcpname":"THE CROSS-OVER MINISTRY INC","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":["NO DATA","I10.","N17.9","E86.0","E11.9","K29.00","E87.2","M10.9","K21.9","Z79.84","Z83.3","Z91.14","Z56.0","R11.2","Z00.00","E13.9","G47.00","U07.1"],"date":["2020-11-11","2020-11-11","2020-11-25","2020-11-09","2020-11-12","2020-11-09","2020-11-11","2020-11-25","2020-11-08","2020-11-08","2020-11-08","2020-11-08","2020-11-08","2020-11-08","2020-11-25","2020-11-25","2020-11-25","2021-01-11"],"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":[["","64980028105","GLIPIZIDE","TAB 10MG","30","Select","Select",""],["","00002822259","INSULIN","INJ 100\/ML","45","Select","Select",""],["","","LANTUS","INJ 100\/ML","","Select","Select",""],["","61314063006","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","4480","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","45","Select","Select",""],["","","HUMALOG","INJ 100\/ML","","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","","ONETOUCH","MIS LANCETS","","Select","Select",""],["","16729013401","ALLOPURINOL","TAB 100MG","90","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","180","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","12","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","","BD  PEN NEEDL","MIS 32GX5\/32","","Select","Select",""],["","","COLCHICINE","TAB 0.6MG","","Select","Select",""],["","","PNEUMOVAX","INJ 25\/0.5","","Select","Select",""],["","","BOOSTRIX","INJ ","","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","","PREVNAR","INJ ","","Select","Select",""],["","","AFLURIA","INJ 2020-21","","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":""}]}]}