{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARDNASSSAB ","gend":1,"add":"HT92 E 017C3 TPA TS ","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1946-12-16","age":"","mstatus":"","insh":"63200210*16","cliId":"","pno":"69\/7577529-2","cno":"757\/351-9666","email":"","ename":"","eno":"","pphy":"GRANT JR, THOMAS R MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE STE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","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":["R35.0","F20.0","H91.90","F03.91","R46.89","R41.3","Z63.6","F32.9","F20.9","NO DATA","M48.07","M51.36","G30.9","F02.80","Z23.","I08.1","D64.9","R53.83","R19.4","R39.15","Z01.419","B37.3","F41.9","Z12.11","Z11.59","D12.2","D12.3","K64.8","R06.83","Z87.898","K63.5","N39.46","Z78.0"],"date":["2021-08-23","2021-05-19","2021-07-26","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2021-12-03","2021-12-03","2021-12-17","2019-08-07","2019-08-07","2021-03-27","2021-08-10","2019-04-22","2021-07-22","2021-08-23","2020-07-28","2021-09-10","2020-07-16","2021-04-19","2021-04-21","2021-04-19","2021-04-21","2021-04-21","2021-04-21","2021-08-10","2021-08-10","2021-04-21","2021-08-23","2021-09-10"],"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":[["","23155065105","METRONIDAZOL","TAB 250MG","15","Select","Select",""],["","55111016830","OLANZAPINE","TAB 20MG","30","Select","Select",""],["","65862001130","SERTRALINE","TAB 25MG","30","Select","Select",""],["","31722060730","TOLTERODINE","CAP 2MG ER","90","Select","Select",""],["","00067003028","BENEFIBER","POW DRINK MX","24","Select","Select",""],["","11822447190","VITAMIN","TAB 1000UNIT","30","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","70461001903","FLUAD","INJ 2019-20","0","Select","Select",""],["","00005197102","PREVNAR","INJ ","0","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":""}]}]}