{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AKEEHSINLLEWOP R ","gend":1,"add":" LLABMIK 1313B TPA ECARRET","city":"NORFOLK","state":"VA","zip":23504,"dob":"1992-04-03","age":"","mstatus":"","insh":"6555210*11","cliId":"","pno":"66\/7572080-7","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/446-7900","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":"","pcpname":"Primary Care Specialists","plan":"OHP","program":"Medicaid","lob":"M4","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":["O23.592","B37.3","O23.12","N30.01","Z34.92","Z87.891","O24.419","Z3A.36","Z32.02","Z97.5","Z30.017","S92.155A","Z3A.35","S93.401A","Z3A.37","O24.414","Z3A.38","Z37.0","O24.429","Z88.6","Z91.19","Z20.822","Z30.46","O35.9XX0","O99.212","Z3A.24","O80.","Z23.","Z32.01","Z86.32","V23.9","O99.213","Z3A.31"],"date":["2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2021-01-12","2021-01-05","2019-10-10","2019-10-10","2021-01-18","2021-06-14","2020-12-30","2019-07-15","2021-01-12","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2021-01-16","2020-02-06","2020-10-09","2020-10-09","2020-10-09","2021-01-16","2020-12-01","2020-06-19","2020-06-19","2020-12-01","2020-12-01","2020-12-01"],"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":[["","80681013801","CALCIUM\/D3","TAB 600-5","60","Select","Select",""],["","65162046550","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00904645780","DOK","CAP 100MG","60","Select","Select",""],["","","PRENATAL","TAB MINERALS","","Select","Select",""],["","68382075805","METFORMIN","TAB 500MG","60","Select","Select",""],["","","BD  PEN NEEDL","MIS 32GX4MM","","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","","LANTUS","INJ 100\/ML","","Select","Select",""],["","","ONE","KIT VERIO FL","","Select","Select",""],["","","ONETOUCH","TES VERIO","","Select","Select",""],["","","TERCONAZOLE","CRE 0.004","","Select","Select",""],["","","NYSTAT\/TRIAM","CRE ","","Select","Select",""],["","","CEPHALEXIN","CAP 250MG","","Select","Select",""],["","","SM","SUP 100MG","","Select","Select",""],["","","IRON","TAB 325MG","","Select","Select",""],["","","FLUZONE","INJ 2020-21","","Select","Select",""],["","","MICONAZOLE","SUP 100MG","","Select","Select",""],["","","ACCU-CHEK","TES AVIVA PL","","Select","Select",""],["","","BAQSIMI","POW 3MG\/DOSE","","Select","Select",""],["","","INSULIN","INJ FLEXPEN","","Select","Select",""],["","","NOVOLOG","INJ FLEXPEN","","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":""}]}]}