{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HSENODSSOR A","gend":1,"add":"AIH TOLDIM 0004102 TPA EKPT N","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1994-03-22","age":"","mstatus":"","insh":"6929710*48","cliId":"","pno":"72\/4082486-7","cno":"","email":"","ename":"","eno":"","pphy":"WEBB, CHARLES MD","ppno":"804\/828-4409","pcpadd":"1001 E Leigh Street","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23298,"pcpcounty":"","pcpid":"","pcpname":"MCV ASSOCIATED PHYSICIANS","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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":["F33.2","O99.891","H10.31","Z79.1","Z79.899","Z3A.00","NO DATA","F31.81","F33.9","F41.9","Z34.81","Z71.82","Z3A.09","Z33.1","F43.12","F10.20","N89.8","R10.30","Z11.3","O26.891","R11.0","Z3A.13","Z01.419","N76.0","Z30.011","Z30.432","R35.0","R30.0","F43.10","F33.1","F60.9"],"date":["2021-04-18","2021-11-28","2021-11-28","2021-11-28","2021-11-28","2021-11-28","2021-11-28","2021-09-28","2021-09-28","2021-09-28","2021-11-12","2021-10-15","2021-10-15","2021-10-15","2020-12-30","2020-12-30","2021-02-10","2021-09-16","2021-02-10","2021-09-16","2021-09-16","2021-11-12","2020-10-13","2020-10-13","2020-10-13","2019-07-10","2019-06-20","2019-01-23","2019-08-12","2019-08-12","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":[["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","","TOPIRAMATE","TAB 50MG","","Select","Select",""],["","00093206301","QUETIAPINE","TAB 25MG","60","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","58657017001","M-NATAL","TAB ","100","Select","Select",""],["","","MICROGESTIN","TAB 1.5\/30","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","AZITHROMYCIN","TAB 500MG","","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","5","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","51672130200","TERCONAZOLE","CRE 0.008","20","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","4","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","6","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","00555902742","JUNEL","TAB ","21","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","14","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","30","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":""}]}]}