{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIAMOND   S WHITEHEAD","gend":1,"add":"800 DATHIA CIR APT 292","city":"NEWPORT NEWS","state":"VA","zip":"23601-9998","dob":"2003-10-22","age":"","mstatus":"","insh":"1903576*01","cliId":"","pno":"757\/376-3023","cno":"757\/376-3023","email":"","ename":"","eno":"","pphy":"BADAVI, AURORA MD","ppno":"757\/952-2160","pcpadd":"1033 28TH STREET 2ND FLOOR","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":116806,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/952-2169","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H10.32","S05.92XA","N76.0","Z11.3","Z11.4","Z20.828","Z00.121","R63.4","O03.9","O02.1","M70.51","M70.52","M76.51","M76.52","F34.1","H57.12","R07.89","K21.9","K59.04","R63.0"],"date":["2020-05-29","2020-05-29","2021-04-30","2021-04-30","2021-04-30","2020-12-31","2021-03-25","2021-03-25","2020-02-14","2020-01-30","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-06-11","2020-05-29","2021-09-13","2021-09-13","2021-09-13","2021-09-13"],"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":[["","24208031510","POLYMYXIN ","TRIMETHP","10","Select","Select",""],["","61314012605","KETOROLAC ","0.50%","5","Select","Select",""],["","67877032101","IBUPROFEN ","800MG","90","Select","Select",""],["","00143980350","DOXYCYCL ","100MG","20","Select","Select",""],["","29300022705","METRONIDAZOL ","500MG","14","Select","Select",""],["","24208031510","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","61314012605","KETOROLAC","0.50%","5","Select","Select",""],["","65162046650","IBUPROFEN","800MG","20","Select","Select",""],["","00143980350","DOXYCYCL","100MG","20","Select","Select",""],["","29300022705","METRONIDAZOL","500MG","14","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","120","Select","Select",""],["","00172572860","FAMOTIDINE ","TAB 20MG","60","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":""}]}]}