{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ITNAHSAREKRAP ","gend":1,"add":"IRHC 0012EVA NIATS","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"2002-08-12","age":"","mstatus":"","insh":"8580810*98","cliId":"","pno":"43-7573598-3","cno":"","email":"","ename":"","eno":"","pphy":"ESPINO, STEPHANIE L DO","ppno":"757\/548-0076","pcpadd":"725 VOLVO PKWY STE 100","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"Volvo Medical Associates","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":["F33.1","M25.551","M25.561","L81.0","L70.0","F43.23","M67.51","S39.91XA","J34.0","M25.461","S63.501A","S66.911A","J30.9","M25.531","M25.431","L28.0","J45.20","Z91.010","Z91.018","Z91.011","L20.84","K02.9","J45.30","N94.4","N76.0","Z30.9","L20.9","K01.1"],"date":["2020-07-20","2020-10-06","2020-10-06","2020-07-20","2020-07-20","2020-07-20","2020-10-06","2020-03-19","2021-05-26","2020-08-18","2021-08-11","2021-09-15","2020-03-25","2021-07-20","2021-07-20","2021-05-26","2020-11-18","2020-11-18","2020-11-18","2020-11-04","2020-11-18","2019-07-31","2019-07-31","2019-08-15","2019-08-15","2019-08-15","2019-08-07","2019-07-31"],"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":[["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","20","Select","Select",""],["","00574222545","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","","NAPROXEN","TAB 250MG","","Select","Select",""],["","52187053606","SOD","LIQ 10-5%","170","Select","Select",""],["","66993096045","METRONIDAZOL","CRE 0.0075","45","Select","Select",""],["","","TRIAMCINOLON"," TRIAMCINOLON ","454","Select","Select",""],["","","PROAIR"," PROAIR ","17","Select","Select",""],["","","CETIRIZINE"," CETIRIZINE ","30","Select","Select",""],["","47335099436","WINLEVI","CRE 0.01","60","Select","Select",""],["","","EPINEPHRINE","INJ 0.3MG","","Select","Select",""],["","","CYCLOBENZAPR","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":""}]}]}