{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EBONY   DEANNA LU MADHU","gend":1,"add":"1405 MANORWYCK PL APT 103","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1988-04-22","age":"","mstatus":"","insh":"1714065*01","cliId":"","pno":"757\/375-6585","cno":"757\/375-6585","email":"","ename":"","eno":"","pphy":"PATEL, SONAL MD","ppno":"757\/738-1350","pcpadd":"908 EDEN WAY N STE 101","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":207887,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/413-5450","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N97.9","Z32.01","O20.0","O02.1","Z01.818","J30.81","J30.1","J45.20","Z91.018","J11.1","O03.9","E28.2","N92.6","Z00.00","Z23.","Z32.00","O26.20","E28.9","Z31.81","N97.8","B34.9"],"date":["2021-11-15","2020-09-15","2020-08-03","2020-09-25","2020-08-27","2020-03-23","2020-03-23","2020-03-23","2020-03-23","2020-03-23","2020-09-16","2021-03-12","2020-10-27","2020-09-01","2020-03-14","2020-09-10","2020-09-10","2021-03-12","2021-01-12","2021-01-12","2021-09-13"],"priorHcc":[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":[["","59762500801","MISOPROSTOL","200MCG","2","Select","Select",""],["","49502050002","EPIPEN","0.3MG","-4","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00597008717","ATROVENT","17MCG","13","Select","Select",""],["","16729003415","LETROZOLE","2.5MG","10","Select","Select",""],["","49502050002","EPIPEN ","0.3MG","-4","Select","Select",""],["","00597008717","ATROVENT ","17MCG","13","Select","Select",""],["","59762500801","MISOPROSTOL ","200MCG","2","Select","Select",""],["","16729003415","LETROZOLE ","2.5MG","10","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","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":""}]}]}