{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONIA   A WILGIS","gend":1,"add":"6112 GRIMES CT","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"2003-05-26","age":"","mstatus":"","insh":"1893672*01","cliId":"","pno":"757\/419-7079","cno":"757\/419-7079","email":"","ename":"","eno":"","pphy":"FRIAS, ANGELINA MD","ppno":"757\/583-2181","pcpadd":"2203 E LITTLE CREEK RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":122721,"pcpname":"Roosevelt Family Practice","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/480-6482","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.2","T74.11XA","S30.1XXA","S60.222A","Y07.9","R07.89","R06.02","Z91.89","R07.9","R55.","K58.2","N76.0","R10.9","Z11.3","Z72.51","G89.29","Z86.19","R10.84","R11.0","Z30.42","Z32.02","Z71.89","N30.00","A54.9","N89.8"],"date":["2020-10-14","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2020-06-08","2020-06-08","2020-04-21","2020-06-08","2020-06-08","2020-03-24","2020-06-29","2020-10-05","2020-06-29","2021-01-11","2020-10-05","2020-10-05","2021-01-11","2020-01-21","2020-01-21","2020-01-21","2020-07-03","2021-08-21","2021-08-24","2021-08-21"],"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":[["","59310057922","PROAIR ","","8","Select","Select",""],["","00591079501","DICYCLOMINE ","20MG","60","Select","Select",""],["","68462010530","ONDANSETRON ","4MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","8","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00456315467","AEROCHAMBER ","PLUS","1","Select","Select",""],["","64679096401","AZITHROMYCIN ","500MG","2","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","60","Select","Select",""],["","68462010530","ONDANSETRON","4MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","69452015120","VITAMIN","50000UNT","8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00456315467","AEROCHAMBER","PLUS","1","Select","Select",""],["","64679096401","AZITHROMYCIN","500MG","2","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","28","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":""}]}]}