{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACKELINE ORTIZ","gend":1,"add":"2511 E PRINCESS ANNE ROAD","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1971-01-15","age":"","mstatus":"","insh":"20041368*01","cliId":"","pno":"757\/237-2823","cno":"757\/237-2823","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":"OHCC","region":"TIDEWATER","aligned":"","ano":"","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":["J45.50","J44.9","J41.1","K21.9","S52.572A","Z20.828","E55.9","F32.9","E66.01","Z68.41","M47.812","M47.816","M15.3","E11.65","E78.5","Z79.4","J30.2","R09.82","E11.00","F41.1","R13.19","K75.81","Z80.0","K22.70","G56.02","R52.","R20.0","Z20.822","N76.0","E11.8","L73.2","B37.3","R30.0","E11.39","E11.3293","H25.13","H04.123","K31.84","J30.0","J30.9","Z68.42","E11.9","E11.3299","E66.9","F41.9","F41.0","Z01.411","R32.","S52.592A","G56.01","M79.675"],"date":["2020-08-26","2020-08-26","2020-04-09","2020-08-26","2020-12-15","2021-04-05","2021-05-24","2021-05-07","2021-05-24","2021-05-07","2020-01-21","2020-01-21","2020-01-21","2021-05-24","2020-05-12","2021-07-19","2020-08-26","2020-08-26","2020-08-26","2020-03-13","2020-06-23","2020-06-23","2020-06-23","2020-06-23","2020-12-15","2020-12-15","2020-12-15","2021-03-04","2021-05-10","2021-07-19","2020-01-10","2020-07-08","2020-01-10","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2021-05-24","2020-05-28","2020-05-28","2020-07-09","2020-08-05","2020-09-25","2020-09-25","2020-04-09","2020-04-09","2020-07-08","2020-07-08","2020-07-20","2020-12-21","2021-06-21"],"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":[]},{"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":""}]}]}