{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A   EELAROCNOTRETTEB ","gend":1,"add":"ERC RETAW 6103B2 TPA STC KE","city":"MIDLOTHIAN","state":"VA","zip":"23112-9998","dob":"1993-08-27","age":"","mstatus":"","insh":"73400210*25","cliId":"","pno":"63\/4086975-3","cno":"","email":"","ename":"","eno":"","pphy":"WEBB, CHARLES MD","ppno":"804\/828-4409","pcpadd":"401 N 11TH STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23219,"pcpcounty":"","pcpid":"","pcpname":"MCV ASSOCIATED PHYSICIANS","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","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":["O03.1","O73.1","S02.5XXA","K04.7","K02.9","X58.XXXA","Y92.89","Y93.89","J11.1","K08.89","Z92.29","R53.1","E55.9","H93.299","H53.8","R06.02","R94.31","S46.912A","M54.2","K05.30","K01.0","O21.9","Z3A.01","H60.393","F41.8","H60.399","R00.2","I10.","R79.9","O03.4","Z20.822","I34.1","M41.9","Z88.8","F17.200","R50.9","Z87.891","Z86.2","Z3A.00","R11.2","O03.39","D62.","U07.1"],"date":["2021-12-28","2021-12-28","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2020-02-07","2021-01-18","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2019-06-27","2019-06-27","2019-09-16","2019-09-16","2021-12-01","2021-12-01","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2019-07-15","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2019-09-16","2019-09-16","2021-12-01","2021-12-01","2021-12-01","2021-12-01","2021-12-28","2021-12-28","2021-12-28"],"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":[["","","SERTRALINE"," SERTRALINE ","30","Select","Select",""],["","","CYCLOBENZAPR"," CYCLOBENZAPR ","15","Select","Select",""],["","","AMOX\/K"," AMOX\/K ","20","Select","Select",""],["","","BUTALB\/ACETA"," BUTALB\/ACETA ","30","Select","Select",""],["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","","BUTAL\/APAP"," BUTAL\/APAP ","30","Select","Select",""],["","","SUMATRIPTAN","TAB 25MG","","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":""}]}]}