{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ANNA E TUFTEE","gend":1,"add":"1928 FORGE RD","city":"TOANO","state":"VA","zip":"23168-9998","dob":"1999-05-31","age":"","mstatus":"","insh":"1399692*01","cliId":"","pno":"757\/810-0815","cno":"757\/810-0815, 757\/810-0815, ","email":"","ename":"","eno":"","pphy":"HARRISON, JARED S DO","ppno":"757\/345-0011","pcpadd":"7364 RICHMOND ROAD","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":"23188-9998","pcpcounty":"","pcpid":118380,"pcpname":"Riverside Primary Care Norge","plan":"OHP - OPTIMA","program":"ACA","lob":"Individual","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":["D69.3","R76.8","R80.9","L25.9","N20.0","N30.00","R11.0","D48.5","F90.0","Z20.828","L90.5","N13.2","F90.9","R10.9","N20.1","Z01.812","Z20.822","R52.","D69.6","Z11.1","N23."],"date":["2021-06-10","2021-06-10","2021-06-10","2020-11-05","2021-05-12","2021-04-30","2021-04-30","2021-01-04","2021-05-12","2021-01-18","2021-03-04","2021-04-29","2021-04-29","2021-04-29","2021-05-01","2021-05-08","2021-05-08","2021-05-12","2020-06-18","2020-12-01","2021-05-01"],"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":[["","57237001401","TAMSULOSIN","0.4MG","14","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","-14","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","10","Select","Select",""],["","00093031401","KETOROLAC","10MG","12","Select","Select",""],["","42858010201","OXYCOD\/APAP","5-325MG","18","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","12","Select","Select",""],["","75826011510","PHENAZOPYRID","200MG","15","Select","Select",""],["","00228306311","AMPHET\/DEXTR","15MG ER","30","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","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","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":""}]}]}