{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EBONY HURDLE","gend":1,"add":"1718 WEAVER ST","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1982-10-12","age":"","mstatus":"","insh":"1548508*01","cliId":"","pno":"757\/339-4589","cno":"757\/339-4589","email":"","ename":"","eno":"","pphy":"ANTOINE, ANGELA DO","ppno":"757\/424-4442","pcpadd":"6632 INDIAN RIVER RD STE 104","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":122066,"pcpname":"Nowcare Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/523-4765","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K08.89"],"date":["2020-04-20"],"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":[["","00536123441","ASPIRIN ","81MG EC","30","Select","Select",""],["","55513080060","CORLANOR ","5MG","60","Select","Select",""],["","00078077720","ENTRESTO ","49-51MG","60","Select","Select",""],["","76385011150","CARVEDILOL ","6.25MG","60","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","30","Select","Select",""],["","57237002901","AMOXICILLIN ","875MG","20","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20","Select","Select",""],["","59779060027","CVS ","81MG EC","90","Select","Select",""],["","00078077720","ENTRESTO","49-51MG","60","Select","Select",""],["","00536123441","ASPIRIN","81MG EC","30","Select","Select",""],["","55513080060","CORLANOR","5MG","60","Select","Select",""],["","76385011150","CARVEDILOL","6.25MG","60","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","59779060014","CVS","81MG EC","90","Select","Select",""],["","57237002901","AMOXICILLIN","875MG","20","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","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}