{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA   YVETTE WATSON","gend":1,"add":"2831 KELLER AVE","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1971-07-16","age":"","mstatus":"","insh":"1556581*01","cliId":"","pno":"757\/857-1643","cno":"757\/857-1643","email":"","ename":"","eno":"","pphy":"NEWBY-GOODMAN, MARCIA MD","ppno":"757\/942-8020","pcpadd":"930 MAJESTIC AVE STE 220","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":100347,"pcpname":"Primary Care Specialists","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/942-8015","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","Z12.31","Z01.419"],"date":["2021-06-07","2021-10-04","2021-11-15"],"priorHcc":["",null,null]}},{"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":[["","16729018317","HYDROCHLOROT","25MG","30","Select","Select",""],["","68382018201","BUSPIRONE","15MG","90","Select","Select",""],["","65862001330","SERTRALINE","100MG","60","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","16729018317","HYDROCHLOROT ","25MG","30","Select","Select",""],["","65862001330","SERTRALINE ","100MG","60","Select","Select",""],["","68382018201","BUSPIRONE ","15MG","90","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","70461032103","FLUCLVX ","2021-22","0","Select","Select",""],["","70461032103","FLUCLVX","2021-22","0","Select","Select",""],["","68180021509","LOSARTAN\/HCT ","TAB 50-12.5","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","",""],["Yes","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":""}]}]}