{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"T AINROLYA","gend":1,"add":"RAES EKAJ 6795301 TPA RIC S","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1978-02-28","age":"","mstatus":"","insh":"65600210*21","cliId":"","pno":"09\/7579192-7","cno":"757\/907-2919","email":"","ename":"","eno":"","pphy":"KNITTIG, SOMMER MD","ppno":"757\/312-6267","pcpadd":"908 EDEN WAY N STE 101","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"","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":["E66.01","K42.0","Z68.45","E78.00","K21.9","F32.9","Z87.891","K76.0","K66.0","G47.33","I87.8","M12.9","Z91.5","F31.9","F43.23","F31.4","F41.1","F41.0","F43.29","Z30.430","Z32.02","F33.1","F41.9","D64.89","F51.01","Z98.84","K91.2","Z68.44","M15.3","F32.81","G47.01","Z51.81","Z71.3","Z71.82","E88.81","I89.0","R63.8"],"date":["2022-09-13","2020-07-13","2020-07-13","2021-04-07","2020-07-13","2020-07-13","2020-07-13","2020-07-13","2020-07-13","2020-07-13","2020-07-13","2020-07-13","2020-07-13","2022-09-13","2020-11-17","2021-12-07","2021-12-07","2021-12-07","2022-06-09","2020-08-18","2020-08-18","2022-05-17","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2022-09-13","2022-09-13","2020-07-08","2021-12-07","2020-12-16","2021-08-09","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-09-13"],"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":[]},{"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":[["","45963014205","BUPROPN","TAB 300MG XL","11","Select","Select",""],["","67877043303","ARIPIPRAZOLE","TAB 15MG","30","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","90","Select","Select",""],["","00169280015","SAXENDA","INJ 18MG\/3ML","15","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","90","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","25","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","15","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","15","Select","Select",""],["","62541020230","QSYMIA","CAP 7.5-46MG","30","Select","Select",""],["","64764017530","DEXILANT","CAP 60MG DR","90","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","10","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","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":""}]}]}