{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NNYLYARSLEINAD","gend":1,"add":" TSEW W 10628091 TPA EVA","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1997-01-27","age":"","mstatus":"","insh":"80500210*09","cliId":"","pno":"49\/7572797-7","cno":"757\/947-7972","email":"","ename":"","eno":"","pphy":"TOUCHET, BRADLEY J MD","ppno":"757\/594-3800","pcpadd":"10510 JEFFERSON AVENUE STE A","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23601,"pcpcounty":"","pcpid":"","pcpname":"Riverside Brentwood 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":["Z23.","R07.89","F43.10","Z00.00","F41.9","U07.1","F33.2","F31.9","Z91.81","Z79.3","Z79.899","R07.9","Z20.822","Z32.02","Z30.09","V62.84"],"date":["2021-04-30","2022-08-06","2020-09-21","2021-04-09","2021-05-27","2021-09-04","2021-07-02","2021-07-20","2022-08-06","2022-08-06","2022-08-06","2022-08-06","2022-08-14","2021-07-02","2021-07-02","2021-07-19"],"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":[]},{"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":[["","00555901658","SPRINTEC","TAB 28 DAY","28","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","30","Select","Select",""],["","29300041319","CYCLOBENZAPR","TAB 5MG","12","Select","Select",""],["","00093585105","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","42806008301","BUSPIRONE","TAB 7.5MG","180","Select","Select",""],["","51991074810","DULOXETINE","CAP 60MG","90","Select","Select",""],["","68180044601","QUETIAPINE","TAB 50MG","120","Select","Select",""],["","00527551337","AMPHET\/DEXTR","CAP 20MG ER","30","Select","Select",""],["","54092038701","ADDERALL","CAP 20MG","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":""}]}]}