{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ETSEVLYSDNALSI R","gend":0,"add":"NALSSORC 5014 TPA EVA D","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1985-05-03","age":"","mstatus":"","insh":"69200210*26","cliId":"","pno":"07\/4341362-9","cno":"","email":"","ename":"","eno":"","pphy":"PACIFICO, MICAH NP","ppno":"434\/835-4876","pcpadd":"949 PINEY FOREST RD","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"GO DOCS","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CHARLOTTESVILLE WESTERN","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":["E11.9","E78.2","Z68.34","F79.","G40.909","H66.003","R11.2","G47.33","E55.9","E78.5","G47.30","F20.0","F41.9","Z71.3","Z71.82","E66.9","Z23.","F22.","G40.219","F81.89","F32.9","F20.9","G40.019","H40.023","R05.","F31.9","G40.509","Z79.899","R56.9","N18.2","R80.1","E11.22","R09.02","NO DATA","F29.","G40.109","R44.3","Z79.84","H35.363","H25.13","G40.209","Z00.00","G40.911","G40.919","G40.009","R62.50","F32.0"],"date":["2021-12-14","2021-01-04","2021-01-04","2021-07-27","2021-01-04","2021-01-27","2021-01-27","2021-02-17","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2020-12-29","2021-08-02","2020-12-29","2020-12-29","2021-11-17","2021-08-01","2021-09-01","2020-03-20","2021-09-16","2020-01-10","2021-07-27","2020-05-30","2021-11-10","2021-11-10","2021-11-10","2020-05-30","2021-10-11","2021-11-17","2021-07-27","2021-07-27","2021-07-27","2021-02-03","2021-02-03","2021-08-04","2019-01-23","2019-06-14","2019-06-27","2019-06-24","2019-06-24","2019-08-12"],"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":[["","63402020660","APTIOM","TAB 600MG","60","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","6","Select","Select",""],["","70756021590","FENOFIBRATE","TAB 160MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00131248035","VIMPAT","TAB 200MG","75","Select","Select",""],["","50474050015","NAYZILAM","SPR 5MG","2","Select","Select",""],["","31722088390","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","13","Select","Select",""],["","00378623201","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","180","Select","Select",""],["","43547034350","RISPERIDONE","TAB 3MG","90","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","20","Select","Select",""],["","53885000810","ONETOUCH","MIS PLUS 33G","100","Select","Select",""],["","68180051202","LISINOPRIL","TAB 2.5MG","90","Select","Select",""],["","63824002314","MUCINEX","TAB 1200MG","20","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}