{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAVISH PERRY","gend":0,"add":"5140 VENETIAN LN APT 208","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1992-05-17","age":"","mstatus":"","insh":"20033351*01","cliId":"","pno":"757\/749-8539","cno":"757\/749-8539","email":"","ename":"","eno":"","pphy":"ANYIWO, JOEL O MD","ppno":"757\/689-8430","pcpadd":"1925 GLENN MITCHELL DR STE 100","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":141974,"pcpname":"Princess Anne Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/689-8435","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I87.2","L97.921","L03.116","L08.9","F84.0","F73.","L97.529","L97.822","T14.8XXA","F81.9","Z86.59","S91.302A","I89.0","I82.4Z2","L89.93","L97.521","L97.322","L97.422","L97.221","R39.81","F79.","R78.81","B95.7","D57.1","R60.0","I87.312","E44.0","R62.50","M79.89","Z68.21","Z74.01","M79.672","L97.522","L97.229","Z91.81"],"date":["2020-04-20","2020-01-15","2021-07-12","2021-07-14","2021-11-01","2020-03-16","2021-07-14","2020-04-20","2021-07-14","2021-07-07","2021-07-14","2020-05-01","2021-11-01","2021-07-13","2021-07-12","2021-11-01","2021-11-01","2020-03-04","2021-07-07","2020-05-01","2021-07-06","2021-07-12","2021-07-12","2021-07-06","2021-07-12","2021-11-01","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-29","2021-10-27","2021-11-01"],"priorHcc":["","","","",null,"","","","","","","",null,"","",null,null,"","","","","","","","",null,"","","","","","","",null,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":[["","65862007101","AMOXICILLIN ","400\/5ML","200","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","68180012201","CEPHALEXIN ","500MG","17","Select","Select",""],["","65862007175","AMOXICILLIN","400\/5ML","150","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","68180012201","CEPHALEXIN","500MG","17","Select","Select",""],["","58160088752","FLUARIX","2021-22","0","Select","Select",""],["","58160088752","FLUARIX ","INJ 2021-22","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","",""],["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":""}]}]}