{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  NONNAHSNOOHAC L ","gend":1,"add":"HC SSERPYC 82612E TPA DR LEPA","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1981-10-08","age":"","mstatus":"","insh":"6431710*41","cliId":"","pno":"77\/7573011-4","cno":"757\/485-1738","email":"","ename":"","eno":"","pphy":"CARTER, EBONI MD","ppno":"757\/484-3472","pcpadd":"4868 BRIDGE ROAD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23435","pcpcounty":"","pcpid":"","pcpname":"Bridge Road 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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R05.","Z77.120","R68.89","J06.9","F90.2","F41.1","F51.04","H66.92","H93.8X1","Z20.822","F17.200","H92.02","N30.01","R51.9","R11.2","J30.9","J32.2","H93.93","Z20.828","R19.7","Z11.59","Z01.419","E83.51","Z13.220","Z13.1","Z00.00","G43.909"],"date":["2020-08-19","2020-01-29","2021-03-31","2021-01-04","2020-01-06","2020-01-06","2020-01-06","2021-01-04","2021-01-04","2021-01-04","2021-10-22","2021-01-04","2021-10-22","2021-10-22","2021-10-22","2021-01-27","2021-01-27","2021-01-27","2021-01-07","2020-08-19","2020-08-19","2021-12-20","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27"],"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":[["","54092039101","ADDERALL","CAP 30MG","30","Select","Select",""],["","51672413204","LAMOTRIGINE","TAB 150MG","60","Select","Select",""],["","67877024201","QUETIAPINE","TAB 25MG","15","Select","Select",""],["","13668033101","TRAZODONE","TAB 100MG","30","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","00406889201","AMPHET\/DEXTR","TAB 10MG","30","Select","Select",""],["","0",""," ","600","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","69367020301","BUT\/APAP\/CAF","TAB ","15","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":""}]}]}