{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CYNTHIA TAYLOR","gend":1,"add":"13213 AQUEDUCT DR APT 7","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"1957-11-07","age":"","mstatus":"","insh":"20035970*01","cliId":"","pno":"202\/360-7596","cno":"202\/360-7596","email":"","ename":"","eno":"","pphy":"HIOTELLIS, APOSTOLOS MD","ppno":"757\/659-6287","pcpadd":"860 OMNI BLVD SUITE 112","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":161262,"pcpname":"TPMG CITY CENTER FAMILY MEDICINE","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/232-2480","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.572","W18.43XA","Z96.9","R10.9","R19.7","K21.9","N39.46","E11.9","M19.011","M62.838","G62.9","R10.84","Z90.49","E11.65","Z79.84","I10.","E78.01","M19.041","M19.042","M25.511","G89.29","R63.4","F31.30","F43.10","M25.532","J20.9","Z72.0","S93.402A","B37.3","F43.20","N76.0","L02.215","Z20.828","J18.9","J01.10","M54.5","R53.1","R52.","R00.0","R07.9","E87.6"],"date":["2020-09-29","2020-08-21","2020-08-21","2020-12-29","2021-05-02","2020-09-30","2021-03-10","2021-03-10","2021-03-19","2021-03-19","2020-09-29","2020-10-15","2020-10-15","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-03-23","2021-03-23","2021-06-28","2021-06-01","2021-06-01","2020-01-20","2020-07-21","2021-03-01","2020-08-13","2020-08-13","2021-03-09","2020-09-18","2020-09-18","2021-03-01","2021-03-01","2021-03-01","2020-12-29","2020-07-17","2020-07-17","2020-07-17","2021-05-02","2021-05-02"],"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":[]},{"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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}