{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" UECGNIL","gend":0,"add":"NINNEP 54EVA NOTG","city":"NEWPORT NEWS","state":"VA","zip":"23606-9998","dob":"1980-07-24","age":"","mstatus":"","insh":"9531210*88","cliId":"","pno":"4775744126","cno":7576632169,"email":"","ename":"","eno":"","pphy":"ASPILI, CONCEPCION MD","ppno":"757\/874-8400","pcpadd":"4714 MARSHALL AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":"","pcpname":"PENINSULA INSTITUTE FOR COMMUNITY HEALTH","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":["B20.","E11.9","E78.5","E66.8","I10.","Z71.89","Z23.","R05."],"date":["2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2020-03-05"],"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":[["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","","POT  CHLORIDE"," POT  CHLORIDE","60","Select","Select",""],["","","ODEFSEY"," ODEFSEY ","30","Select","Select",""],["","","METFORMIN"," METFORMIN ","60","Select","Select",""],["","","JARDIANCE","TAB 25MG","","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","","JANUVIA"," JANUVIA ","30","Select","Select",""],["","00378632477","VALSART\/HCTZ","TAB 320-12.5","30","Select","Select",""],["","00005197102","PREVNAR","INJ ","0","Select","Select",""],["","","LISINOP\/HCTZ"," LISINOP\/HCTZ ","30","Select","Select",""],["","","PRAVASTATIN"," PRAVASTATIN ","30","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","CODEINE\/GG","SOL 10-100\/5","","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":""}]}]}