{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHEYENNE   R GELARDOS","gend":1,"add":"3109 SCOTT ST","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"2000-06-05","age":"","mstatus":"","insh":"6247903*01","cliId":"","pno":"757\/282-8443","cno":"757\/282-8443","email":"","ename":"","eno":"","pphy":"EMEJURU, OGUBUIKE MD","ppno":"757\/436-2300","pcpadd":"513 BAYLOR CT","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":140011,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z32.02","F41.3","B85.0","O02.1","N93.9","O03.9","R55."],"date":["2021-06-13","2021-06-13","2021-06-13","2020-04-20","2020-04-18","2020-04-18","2021-08-03"],"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":[["","00093314705","CEPHALEXIN ","500MG","15","Select","Select",""],["","68382039801","POT  CHLORIDE","20MEQ ER","4","Select","Select",""],["","00904671960","ACETAMINOPHE ","325MG","20","Select","Select",""],["","42192032330","PNV-DHA ","DOCUSATE","30","Select","Select",""],["","00555032302","HYDROXYZ ","25MG","30","Select","Select",""],["","62332002231","FLUOXETINE ","10MG","30","Select","Select",""],["","21922002107","PERMETHRIN ","5%","60","Select","Select",""],["","68382039801","POT CHLORIDE","20MEQ ER","4","Select","Select",""],["","42192032330","PNV-DHA","DOCUSATE","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","15","Select","Select",""],["","00904671960","ACETAMINOPHE","325MG","20","Select","Select",""],["","21922002107","PERMETHRIN","5%","60","Select","Select",""],["","62332002231","FLUOXETINE","10MG","30","Select","Select",""],["","00555032302","HYDROXYZ","25MG","30","Select","Select",""],["","00574200830","NYSTOP ","POW 100000","30","Select","Select",""],["","00904531346","PRENATAL ","TAB 27-0.8MG","30","Select","Select",""],["","00115164501","NITROFUR ","CAP 100MG","40","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","",""],["No","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":""}]}]}