{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  NAHTANOJNAMTUP J ","gend":0,"add":"TRAGOB 303A TPA TS ","city":"FRANKLIN","state":"VA","zip":"23851-9998","dob":"1964-12-18","age":"","mstatus":"","insh":"90600210*03","cliId":"","pno":"92\/7573509-7","cno":"","email":"","ename":"","eno":"","pphy":"GUZMAN-LEE, JOJO-ANNE MD","ppno":"757\/955-2828","pcpadd":"885 KEMPSVILLE RD SUITE 320","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"AMELIA MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","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":["F33.3","F33.2","F41.1","K70.31","Z68.20","I10.","J44.9","E87.1","F32.9","F41.9","F10.20","F17.210","Z91.81","R14.0","E88.09","R60.1","Z28.21","K27.9","Z79.899","K21.9","G56.00","Z13.31","F10.10","M25.561","F33.1","R53.82","M25.562","F10.929","F10.220","J43.9","K74.60","R18.8","R10.9","Z12.11","Z68.1","F17.200","K26.3","K26.5","K27.5","K25.5","R07.9","Z68.22","V58.89","M17.0","K27.1"],"date":["2020-05-22","2020-06-11","2021-08-02","2021-01-05","2020-11-30","2021-01-05","2021-10-01","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2020-11-28","2020-11-30","2020-11-28","2020-11-28","2020-11-30","2020-11-28","2020-12-07","2020-12-29","2020-12-29","2020-06-02","2020-02-14","2020-02-14","2020-02-14","2020-02-14","2020-06-05","2020-06-05","2020-11-30","2021-05-26","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-03-17","2021-05-26","2019-12-06","2019-12-07","2019-12-07","2019-12-06","2019-10-14","2019-11-15","2019-11-15","2019-12-07"],"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":[["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","31","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","946","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","65862069790","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","65862049101","QUETIAPINE","TAB 100MG","90","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","62037099901","POT  CL MICRO","TAB 20MEQ ER","90","Select","Select",""],["","00904053961","THERA","TAB ","90","Select","Select",""],["","00378668999","PANTOPRAZOLE","TAB 40MG","90","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":""}]}]}