{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUIRAUQASDLEIF ","gend":1,"add":"TOLDIM 4304EKPT NAIH ","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1998-07-06","age":"","mstatus":"","insh":"8881510*37","cliId":"","pno":"52\/4082406-6","cno":"","email":"","ename":"","eno":"","pphy":"STEELE, BARBARA JEAN MD","ppno":"804\/780-0840","pcpadd":"SUITE 206 2809 NORTH AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23222,"pcpcounty":"","pcpid":"","pcpname":"VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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","R11.2","R63.4","R10.84","O26.893","M54.9","Z3A.36","Z79.899","O36.8190","O36.5130","Z3A.37","F41.9","Z32.01","O21.2","Z37.0","Z3A.39","O36.5930","O21.0","R94.31","R07.9","F41.0","E86.0","R19.7","F17.210","F32.9","K21.9","R06.02","R09.81","R42.","F41.8","F33.9","F31.81","O21.9","Z3A.08","O99.619","O35.8XX0","Z3A.19","K80.20","O99.89","R10.13","Z3A.29","Z38.00","P05.19","Z23.","P04.81","Q38.1","Z59.0","F33.2","O36.80X0","Z32.02","P92.8","R53.1","F43.10","Z68.28","Z68.29","Z04.9"],"date":["2021-08-27","2021-06-12","2020-07-24","2020-08-15","2020-08-15","2020-08-15","2020-08-15","2020-08-15","2020-08-15","2020-08-27","2020-08-27","2021-06-12","2021-08-20","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2021-08-29","2020-10-11","2020-11-18","2021-06-12","2021-06-12","2021-06-12","2021-06-12","2021-06-12","2021-08-29","2021-06-12","2021-06-12","2021-06-12","2021-08-11","2021-08-11","2021-08-11","2021-08-29","2021-08-29","2021-08-29","2021-11-16","2021-11-16","2021-01-27","2020-06-30","2020-06-30","2020-06-30","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2021-01-31","2021-05-25","2021-05-25","2020-09-21","2021-08-29","2020-10-13","2020-12-21","2021-01-27","2021-06-13"],"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":[["","64380080807","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","28","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","20","Select","Select",""],["","00363010706","WAL-DRYL","CAP 25MG","20","Select","Select",""],["","49884068905","METOCLOPRAM","TAB 10MG","20","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":""}]}]}