{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   REBMAREVAEW E","gend":1,"add":"HSAW EGROEG 1083B TPA YWH NOTGNI","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"1990-07-23","age":"","mstatus":"","insh":"6952210*29","cliId":"","pno":"16\/7578207-8","cno":"757\/618-7028","email":"","ename":"","eno":"","pphy":"GRAY, DERWIN P MD","ppno":"757\/547-2322","pcpadd":"1101 MADISON PLAZA STE 100 & 200","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","F12.20","F15.20","F43.10","Z20.822","F31.31","Z79.899","N92.5","E03.9"],"date":["2021-03-21","2020-12-01","2020-10-08","2022-04-01","2022-08-14","2020-01-19","2022-01-07","2022-05-03","2022-06-24"],"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":[["","64380080707","IBUPROFEN","TAB 800MG","12","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","60","Select","Select",""],["","16729044315","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","65862050220","AMOX\/K","TAB 500-125","23","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","28","Select","Select",""],["","68462010805","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","43547034050","RISPERIDONE","TAB 0.5MG","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","946","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","30","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","45","Select","Select",""],["","00185041060","BUPROPION","TAB 100MG SR","30","Select","Select",""],["","49884070155","CLOMIPHENE","TAB 50MG","5","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":""}]}]}