{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NIVLEKPPAM ","gend":0,"add":"H 9201TS TLO","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1970-12-21","age":"","mstatus":"","insh":"7230210*45","cliId":"","pno":"49\/7577668-4","cno":"","email":"","ename":"","eno":"","pphy":"FP-CARE INC, FOCUS FP","ppno":"617\/304-5967","pcpadd":"500 W CUMMINGS PARK STE 2700","pcpcity":"WOBURN","pcpstate":"MA","pcpzip":1801,"pcpcounty":"","pcpid":"","pcpname":"FOCUS CARE SOLUTIONS INC","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":["Z23.","G47.33","R53.1","Z86.73","R76.0","K14.8","G47.9","R06.83","M25.511","G47.00","I10.","Z12.11","Z71.89","M25.571","G89.29","Z00.00","Z11.4","Z13.39","Z99.89","R73.03","Z12.5","R63.5","R93.89","Z91.14","R21.","E66.01","Z68.39","Z79.82","Z79.899","E29.0","I63.9","R07.9","R32.","I48.91"],"date":["2021-08-18","2021-08-18","2019-08-19","2020-06-08","2019-08-19","2019-08-19","2019-08-19","2019-12-08","2021-03-01","2019-12-08","2021-08-18","2021-03-01","2021-03-01","2021-03-01","2021-03-01","2021-08-18","2020-07-20","2020-07-20","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2019-02-19","2019-02-19","2019-02-19","2019-12-08","2019-12-08","2019-12-08","2020-06-08","2019-12-08","2020-08-31","2020-06-09","2020-06-08","2020-06-08"],"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":[["","","HYDROCHLOROT"," HYDROCHLOROT ","30","Select","Select",""],["","","LOSARTAN","TAB 50MG","","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","","TAMSULOSIN","CAP 0.4MG","","Select","Select",""],["","","ELIQUIS","TAB 5MG","","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":""}]}]}