{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIVINIDAD LUMBOY","gend":1,"add":"921 VEVAFTATOR RUN","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1949-05-22","age":"","mstatus":"","insh":"900046224*01","cliId":"","pno":"714\/643-3313","cno":"","email":"","ename":"","eno":"","pphy":"HOWELL, CHRISTINE NP","ppno":"757\/955-2828","pcpadd":"885 KEMPSVILLE RD STE 320","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"AMELIA MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"N","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/955-2829","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.11","E78.5","I10.","K21.9","E11.9","Z12.31","E78.00","Z00.00"],"date":["2021-05-23","2021-03-30","2021-06-03","2021-03-30","2021-06-03","2021-06-03","2021-06-03","2020-12-30"],"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":[]}]},{"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":[["","53885000810","ONETOUCH DELICA PLUS LANCETS EXTRA FINE 33G                           ","PLUS 33G","100","Select","Select",""],["","53885014301","ONETOUCH DELICA LANCETS EXTRA FINE 33G                                ","LANCETS","100","Select","Select",""],["","68645051054","HYDROCHLOROTHIAZIDE                                                   ","25MG","90","Select","Select",""],["","53885044801","ONETOUCH ULTRA 2                                                      ","ULTRA 2","1","Select","Select",""],["","00093505898","ATORVASTATIN CALCIUM                                                  ","40MG","90","Select","Select",""],["","45802015065","ALOGLIPTIN                                                            ","25MG","30","Select","Select",""],["","31722070290","LOSARTAN POTASSIUM                                                    ","100MG","90","Select","Select",""],["","68645058459","METFORMIN HYDROCHLORIDE                                               ","1000MG","180","Select","Select",""],["","53885024510","ONETOUCH ULTRA                                                        ","ULTRA","100","Select","Select",""],["","68645057454","GLIPIZIDE                                                             ","5MG","180","Select","Select",""],["","00093727156","PIOGLITAZONE HYDROCHLORIDE                                            ","15MG","90","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":["",""]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}