{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   EIMOREJDRALOOW B","gend":0,"add":" DNARG 5084YAW SRETSAM","city":"WOODBRIDGE","state":"VA","zip":"22192-9998","dob":"1970-12-16","age":"","mstatus":"","insh":"9602210*26","cliId":"","pno":"14\/1758489-2","cno":"571\/412-9848","email":"","ename":"","eno":"","pphy":"WILLIAMS, RAENELL C MD","ppno":"571\/542-4950","pcpadd":"STE 170 4500 POND WAY","pcpcity":"WOODBRIDGE","pcpstate":"VA","pcpzip":22192,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN\/ WINCHESTER","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":["F10.239","F10.929","F10.10","E87.0","R03.0","I16.0","F17.200","R74.0","F10.129","F31.4","E86.0","E83.42","F17.210","F17.290","I10.","L40.0","G62.9","F10.20","F39.","S60.112A"],"date":["2020-04-13","2020-03-21","2020-04-07","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-04-12","2020-04-12","2020-04-07","2020-04-07","2020-07-03"],"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":[]},{"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":[["","00074055402","HUMIRA","INJ 40\/0.4ML","2","Select","Select",""],["","13668033201","TRAZODONE","TAB 150MG","15","Select","Select",""],["","52565007351","HALOBETASOL","OIN 0.0005","150","Select","Select",""],["","00555015902","CHLORDIAZEP","CAP 25MG","18","Select","Select",""],["","13107006801","AMPHET\/DEXTR","TAB 5MG","30","Select","Select",""],["","69543021712","MAG","TAB 400MG","60","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","180","Select","Select",""],["","65162036111","FOLIC","TAB 1MG","30","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","60","Select","Select",""],["","45802006436","TRIAMCINOLON","CRE 0.001","80","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}