{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ADNILSIRRAH M","gend":1,"add":"TIMS E 4083 TPA TS H","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1964-09-04","age":"","mstatus":"","insh":"78200210*34","cliId":"","pno":"17\/7575164-7","cno":"","email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":"","pcpname":"Bayview Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["F33.2","F70.","U07.1","NO DATA","E87.2","Z00.00","E11.9","F39.","I10.","E78.00","J96.01","N39.0","E87.1","R19.7","K21.9","E66.9","E11.69","E78.2","Z82.3","Z83.3","Z80.1","Z79.84","Z79.899","R69.","Z20.828","E13.10","F31.32","F20.9"],"date":["2021-08-11","2021-08-11","2021-08-23","2021-08-23","2021-08-17","2021-05-13","2021-05-13","2021-05-13","2021-08-18","2021-05-13","2021-08-17","2021-08-23","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-23","2021-08-23","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-17","2021-08-18","2019-08-11","2019-11-19"],"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":[["","70461031903","FLUCLVX","INJ 2019-20","0","Select","Select",""],["","68180031909","BUPROPN","TAB 150MG XL","90","Select","Select",""],["","33342007810","VALSART\/HCTZ","TAB 320-25MG","90","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","150","Select","Select",""],["","","FARXIGA","TAB 5MG","","Select","Select",""],["","55111032101","GLIMEPIRIDE","TAB 2MG","60","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","69097084905","ESCITALOPRAM","TAB 20MG","90","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","4","Select","Select",""],["","","FLUZONE","INJ 2020-21","","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","23155010405","METFORMIN","TAB 1000MG","90","Select","Select",""],["","65862047090","LOSARTAN\/HCT","TAB 100-25","90","Select","Select",""],["","08271036100","LANCETS","MIS THIN","100","Select","Select",""],["","56151014401","TRUPLUS","MIS 30G","100","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","99073017001","FREESTYLE    KIT SYSTEM","KIT SYSTEM","1","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}