{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"E SIRODNOSILL","gend":1,"add":"RC 515TS GIA","city":"NORFOLK","state":"VA","zip":"23523-9998","dob":"1960-03-22","age":"","mstatus":"","insh":"96200210*68","cliId":"","pno":"82\/7573371-5","cno":"","email":"","ename":"","eno":"","pphy":"NEWBY, JAMES E MD","ppno":"757\/627-6892","pcpadd":"STE 220 930 MAJESTIC AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":"","pcpname":"Primary Care Specialists","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["F20.9","G40.501","G40.509","I51.7","R41.9","R94.02","F25.0","F14.20","F10.10","Z23.","N89.8","Z68.27","Z12.39","I25.10","Z68.23","E03.9","G40.909","E78.5","I10.","Z68.25","R63.4","Z72.0","Z68.26","I21.3","Z68.24"],"date":["2022-06-02","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-09-20","2022-09-20","2022-09-20","2021-08-31","2021-12-14","2022-06-02","2021-12-14","2022-09-21","2020-08-03","2021-08-03","2022-06-02","2021-08-03","2020-01-23","2020-01-23","2020-01-23","2020-02-18","2022-09-21","2022-02-02","2020-07-28"],"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":[["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","60505267108","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","68001040203","LEVETIRACETA","TAB 250MG","60","Select","Select",""],["","00378180310","LEVOTHYROXIN","TAB 50MCG","30","Select","Select",""],["","68382014005","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","87701040814","MELATONIN","TAB 5MG","30","Select","Select",""],["","16103035611","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","68382007910","HALOPERIDOL","TAB 5MG","45","Select","Select",""],["","00186077760","BRILINTA","TAB 90MG","60","Select","Select",""],["","59779060027","CVS","TAB 81MG EC","30","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":""}]}]}