{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" WERDNANAMFFOC","gend":1,"add":"DRANYER 0841202 TPA RD ","city":"VIRGINIA BEACH","state":"VA","zip":"23451-9998","dob":"2001-01-12","age":"","mstatus":"","insh":"78300210*11","cliId":"","pno":"72\/7578533-4","cno":"","email":"","ename":"","eno":"","pphy":"ASUNCION, CHRISTOPHER W MD","ppno":"757\/705-5265","pcpadd":"828 HEALTHY WAY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"Mid-Atlantic Family Medicine","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.20","R05.9","F41.1","F90.2","F84.5","F88.","F84.0","F33.41","L70.0","Z20.828","Z03.818","J32.9","Z00.00","Z28.3","F41.9","Z23.","Z20.822","Z11.59","U07.1","F84.9","F90.9","Z02.9","R07.0","B34.9","L90.5","F91.3","J06.9"],"date":["2021-12-21","2021-12-03","2020-01-21","2020-01-21","2020-01-21","2020-06-08","2020-06-08","2020-06-08","2020-09-17","2021-07-22","2021-02-11","2021-11-29","2021-07-15","2021-07-15","2021-07-15","2021-08-10","2021-11-29","2020-09-07","2021-01-06","2019-05-07","2019-04-09","2019-04-23","2019-10-29","2019-02-01","2019-09-17","2019-03-12","2019-10-11"],"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":[["","65862019405","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","51991070505","ALPRAZOLAM","TAB 0.5MG","60","Select","Select",""],["","60758067060","DAPSONE","GEL 0.05","60","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","59762374302","CLINDAMYCIN","GEL 0.01","60","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65862064163","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","31722095801","BENZONATATE","CAP 200MG","30","Select","Select",""],["","66685100200","AMOX\/K","TAB 500-125","20","Select","Select",""],["","00006412102","GARDASIL","INJ ","0","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","27808008602","HYD","SUS 10-8\/5ML","60","Select","Select",""],["","00299590645","EPIDUO","GEL 0.3-2.5%","45","Select","Select",""],["","00023520660","ACZONE","GEL 0.075","60","Select","Select",""],["","51862029550","FABIOR","AER 0.001","50","Select","Select",""],["","00023915530","TAZORAC","CRE 0.0005","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","45802006405","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","51672136403","ADAPAL\/BEN","GEL 0.1-2.5%","45","Select","Select",""],["","00472012645","ADAPALENE","GEL 0.003","45","Select","Select",""],["","51672137302","TAZAROTENE","CRE 0.001","30","Select","Select",""],["","51672138104","CLINDAMY\/BEN","GEL 1-5%","50","Select","Select",""],["","00781261301","AMOXICILLIN","CAP 500MG","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":""}]}]}