{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHELBY WESELY","gend":1,"add":"1204 READON CIR","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1999-01-14","age":"","mstatus":"","insh":"20047819*01","cliId":"","pno":"757\/560-8843","cno":"757\/560-8843","email":"","ename":"","eno":"","pphy":"DESAI, GAUTAM D MD","ppno":"757\/471-6977","pcpadd":"2020 S INDEPENDENCE 3","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23453,"pcpcounty":"","pcpid":310059,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/355-7527","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/471-5300","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","Z46.81","Z79.4","E03.9","E10.65","E10.9","E13.10","I95.9","E86.1","E10.10","E87.1","F84.5","I95.89","D72.829","E66.9","Z96.41","Z79.890","Z83.49","Z82.49","Z68.28","NO DATA","F84.0"],"date":["2020-01-20","2020-07-21","2021-08-20","2021-06-02","2021-08-20","2021-08-20","2020-07-06","2020-06-04","2020-06-04","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-06-02"],"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":{"comment":"","sub":[["","00169750111","NOVOLOG ","100\/ML","20","Select","Select",""],["","69238183407","LEVOTHYROXIN ","100MCG","30","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA BL","300","Select","Select",""],["","73070010011","INSULIN ","100\/ML","10","Select","Select",""],["","00002803101","GLUCAGON ","1MG","1","Select","Select",""],["","00169750111","NOVOLOG","100\/ML","20","Select","Select",""],["","69238183407","LEVOTHYROXIN","100MCG","30","Select","Select",""],["","53885024510","ONETOUCH","ULTRA BL","300","Select","Select",""],["","73070010011","INSULIN","100\/ML","70","Select","Select",""],["","00002803101","GLUCAGON","1MG","1","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":[[["Yes","Select","","","","","Select","",""],["Yes","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":""}]}]}