{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ELOCINSNIKDA M","gend":1,"add":"AW 0091NL STT","city":"RICHMOND","state":"VA","zip":"23223-9998","dob":"1981-08-11","age":"","mstatus":"","insh":"9461510*09","cliId":"","pno":"66\/4082008-3","cno":"","email":"","ename":"","eno":"","pphy":"SHABAN, DANNY MD","ppno":"804\/730-0800","pcpadd":"STE A 8239 MEADOWBRIDGE RD","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":23116,"pcpcounty":"","pcpid":"","pcpname":"Dominion Women's Health","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":["L73.2","Z80.3","NO DATA","Z68.34","A59.01","Z71.89","R73.09","L02.818","E11.65","Z68.41","L02.213","J06.9","E11.319","H52.13","H52.223","M25.561","N12."],"date":["2020-07-24","2020-07-24","2020-08-10","2020-07-24","2021-06-01","2021-06-01","2021-06-01","2020-07-05","2020-07-05","2020-08-10","2021-08-29","2019-06-27","2019-09-13","2019-09-13","2019-09-13","2019-12-12","2020-12-04"],"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":[["","00536110301","ALCOHOL","PAD 0.7","200","Select","Select",""],["","65702061710","ACCU-CHEK","KIT GUIDE","1","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","200","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","60","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","08470046501","COMFORTOUCH","MIS LANCET","100","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","200","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","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":""}]}]}