{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VIUQRAHCEHCYW A","gend":1,"add":"LIMYDNIW 1214B2 TPA RD EL","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1986-01-03","age":"","mstatus":"","insh":"6908110*50","cliId":"","pno":"82\/7575631-5","cno":"","email":"","ename":"","eno":"","pphy":"NELSON, TIA B DO","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST STE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEDICAL GROUP HAMPTON ROADS PRIMARY CARE LLC","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":["F43.23","Z34.81","Z3A.01","I10.","O90.0","R51.9","R09.81","F41.1","O26.892","J01.90","Z3A.20","O13.3","Z3A.29","O16.3","Z3A.35","O10.013","Z3A.36","G89.18","Z01.411","D25.9","B37.3","N92.6","Z30.09","R52.","Z32.02","O10.019","O76.","Z82.49","O34.211","Z37.0","Z79.899","Z01.812","Z3A.39","Z01.419","Z12.39","Z12.4","Z11.51","Z11.3","Z30.40","F41.9","Z39.1","Z3A.38","M54.89","O13.5","O16.9","F33.1","Z34.83","Z3A.33","Z23.","Z33.1","Z30.430","D25.0","Z30.015","Z30.432","Z00.00","E66.01","R51.0","Z20.828","Z80.3","R10.12","E66.3","NO DATA","Z83.71","M54.42","M54.2","G89.29","Z68.37","M72.2","M54.16","H61.23","Z68.38","D64.9","E55.9","Z13.1","Z11.59","Z13.220","Z76.89","Z68.36","Z30.9","Z98.891","Z98.890","J31.0"],"date":["2019-05-22","2019-11-27","2019-11-27","2022-10-06","2020-07-09","2020-12-23","2020-12-23","2022-11-08","2020-02-27","2020-02-27","2020-02-27","2020-04-28","2020-04-28","2020-06-08","2020-06-08","2020-07-03","2020-06-16","2020-07-04","2022-09-12","2022-09-12","2019-02-21","2019-04-11","2019-04-11","2019-04-11","2020-09-04","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2020-07-03","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-07-23","2021-08-19","2022-05-03","2020-06-11","2020-06-26","2020-07-09","2020-07-10","2020-07-03","2020-08-25","2020-05-22","2020-05-22","2022-10-06","2020-05-22","2020-09-04","2020-09-04","2020-11-11","2020-11-11","2019-02-07","2019-02-07","2020-12-23","2022-09-23","2022-09-12","2021-11-19","2021-11-19","2021-11-19","2021-11-19","2022-08-08","2022-07-11","2022-08-08","2022-10-06","2022-07-11","2022-07-11","2022-05-03","2022-05-03","2022-05-03","2022-10-06","2022-05-03","2022-05-03","2022-05-03","2022-05-03","2022-09-12","2022-09-12","2022-09-12","2022-09-12","2022-10-06"],"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":[["","","ETONOGESTREL","MIS ETHY EST","","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","NIFEDIPINE","TAB 60MG ER","","Select","Select",""],["","65162046935","ELURYNG","MIS ","1","Select","Select",""],["","78206014603","NUVARING","MIS ","3","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","15","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","","PRENATE","CAP ","","Select","Select",""],["","00185011701","LABETALOL","TAB 200MG","120","Select","Select",""],["","","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","","PROCTOZONE","CRE -HC 2.5%","","Select","Select",""],["","","DOK","CAP 100MG","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","STOOL","CAP 100MG","","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":""}]}]}