{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELE   M CARUFEL","gend":1,"add":"PO BOX 1152","city":"GLOUCESTER","state":"VA","zip":"23061-9998","dob":"1973-12-05","age":"","mstatus":"","insh":"1678300*01","cliId":"","pno":"804\/210-1954","cno":"804\/210-1954","email":"","ename":"","eno":"","pphy":"LEMING, JOSEPH A MD","ppno":"804\/693-3500","pcpadd":"6760 MAIN STREET","pcpcity":"GLOUCESTER","pcpstate":"VA","pcpzip":23061,"pcpcounty":"","pcpid":174665,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/693-3503","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.011","K08.89","I10.","F12.90","M79.643","Z00.00","F43.12","F43.9","F41.0","H61.23","NO DATA","R29.898","Z13.220","Z11.4","J45.40","F51.04","R06.02","J02.9","R07.89","R68.84"],"date":["2020-02-05","2020-05-09","2020-05-09","2020-02-05","2020-02-05","2020-03-10","2020-09-01","2020-09-01","2020-03-10","2020-03-10","2020-03-10","2020-03-10","2020-03-10","2020-03-10","2020-09-01","2020-09-01","2020-02-24","2020-12-11","2020-02-24","2020-05-12"],"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":[["","67877021901","CEPHALEXIN ","500MG","40","Select","Select",""],["","60505367303","PAROXETIN ","12.5MG","30","Select","Select",""],["","69315090405","LORAZEPAM ","0.5MG","20","Select","Select",""],["","67877024201","QUETIAPINE ","25MG","30","Select","Select",""],["","00406012401","HYDROCO\/APAP ","7.5-325","20","Select","Select",""],["","00093117401","PENICILLN ","500MG","40","Select","Select",""],["","13107015630","PAROXETINE ","30MG","30","Select","Select",""],["","00093310953","AMOXICILLIN ","500MG","12","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00186091612","PULMICORT ","180MCG","1","Select","Select",""],["","62332025118","AZITHROMYCIN ","250MG","6","Select","Select",""],["","65162003310","APAP\/CODEINE ","300-30MG","18","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","40","Select","Select",""],["","60505367303","PAROXETIN","12.5MG","30","Select","Select",""],["","00591024005","LORAZEPAM","0.5MG","20","Select","Select",""],["","00093117401","PENICILLN","500MG","40","Select","Select",""],["","31722094101","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","00093310953","AMOXICILLIN","500MG","12","Select","Select",""],["","13107015630","PAROXETINE","30MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00186091612","PULMICORT","180MCG","1","Select","Select",""],["","67877024210","QUETIAPINE","25MG","30","Select","Select",""],["","65162003310","APAP\/CODEINE","300-30MG","18","Select","Select",""],["","62332025118","AZITHROMYCIN","250MG","6","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","",""],["Yes","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":""}]}]}