{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AURORA   S BADAVI","gend":1,"add":"9123 RIVER CRES","city":"SUFFOLK","state":"VA","zip":"23433-9998","dob":"1950-07-23","age":"","mstatus":"","insh":"900043523*01","cliId":"6JW5Y96WU61","pno":"757\/238-2455","cno":"757\/238-2455","email":"","ename":"","eno":"","pphy":"ASPILI, CONCEPCION MD","ppno":"757\/874-8400","pcpadd":"4714 MARSHALL AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":510019,"pcpname":"","plan":"OHP","program":"MEDICARE","lob":"MA-NON DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/928-0902","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C34.31","B19.10","C79.51","D05.12","Z12.31","C79.31","B18.1","J90.","N83.9","E27.9","M80.80XS","Z01.818","C78.7","R91.8","J96.00","C34.90","H35.372","H90.3","C34.91","I63.9","Z85.3","J18.1","Z98.890","Z12.11","M81.0","D64.9","I08.3","I31.3","I27.9","E78.00","C80.1","R73.9","Z90.12","Z51.11"],"date":["2021-08-18","2021-03-17","2021-08-26","2021-08-18","2021-02-04","2021-08-06","2021-08-12","2021-08-06","2021-03-15","2021-03-15","2021-03-17","2021-04-12","2021-08-06","2021-04-12","2021-04-12","2021-08-12","2021-02-12","2021-07-14","2021-04-12","2021-08-13","2021-08-05","2021-08-05","2021-08-13","2021-05-23","2021-08-12","2021-08-12","2021-08-06","2021-08-06","2021-08-13","2021-08-13","2021-08-06","2021-08-06","2021-08-06","2021-08-26"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","55111016330","OLANZAPINE ","2.5MG","30","Select","Select",""],["","31722053530","TENOFOVIR ","300MG","30","Select","Select",""],["","00093220301","METOCLOPRAM ","10MG","-90","Select","Select",""],["","69315012701","FOLIC ","1000MCG","90","Select","Select",""],["","00310135030","TAGRISSO ","80MG","-30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","55111019690","CLOPIDOGREL ","75MG","30","Select","Select",""],["","16714087603","ATORVASTATIN ","40MG","30","Select","Select",""],["","16729000417","SIMVASTATIN ","10MG","90","Select","Select",""],["","00093220301","","10MG","-90","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}