{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ELIZABETH TORRES","gend":1,"add":"PO BOX 782","city":"CHERITON","state":"VA","zip":"23316-9998","dob":"2001-09-30","age":"","mstatus":"","insh":"7770502*01","cliId":"","pno":"757\/607-6073","cno":"757\/607-6073","email":"","ename":"","eno":"","pphy":"RIOPEL, CATHY MD","ppno":"757\/331-1086","pcpadd":"17068 LANKFORD HWY","pcpcity":"EASTVILLE","pcpstate":"VA","pcpzip":23347,"pcpcounty":"","pcpid":104651,"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":["V23.9","D68.0","Z3A.36","B08.1","M54.5","O80.","Z3A.39","Z37.0","N92.0","Z13.89","R10.2","D50.0","Z23.","O47.03","O23.593","B37.3","Z3A.38","J06.9","O99.113","Z36.85","N76.0","B96.89","R10.31","R10.32","O69.81X0","Z86.2","Z20.828","D69.6","Z11.59","O20.9","Z3A.00","O21.2","V23.7","O99.013","Z3A.29"],"date":["2020-02-19","2021-07-31","2020-02-05","2021-04-09","2020-11-11","2020-02-21","2020-02-21","2020-02-21","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-11-24","2020-01-29","2020-01-29","2020-11-20","2020-02-19","2020-12-01","2021-07-31","2020-01-30","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2020-02-20","2020-02-20","2021-01-08","2020-02-21","2020-10-09","2021-07-31","2021-07-31","2021-07-31","2021-07-31","2021-07-31","2021-07-31"],"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":[["","63044015005","PRENATAL ","LOW IRON","30","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","Select","Select",""],["","00378727253","NORETHINDRON ","0.35MG","28","Select","Select",""],["","51672130200","TERCONAZOLE ","0.80%","20","Select","Select",""],["","00904645780","DOK ","100MG","30","Select","Select",""],["","00904585652","CALCIUM ","600MG","60","Select","Select",""],["","65162046650","IBUPROFEN ","800MG","30","Select","Select",""],["","68180086573","BLISOVI ","Jan-20","28","Select","Select",""],["","99999998189","","","16","Select","Select",""],["","54629060001","DOCUSATE ","100MG","90","Select","Select",""],["","64980023601","METRONIDAZOL ","500MG","14","Select","Select",""],["","00254203080","TRI-PREVIFEM ","","84","Select","Select",""],["","00536440601","VITAMIN ","25MG","60","Select","Select",""],["","53329041009","MEDIPLAST ","40%","1","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","14","Select","Select",""],["","35515094774","QC ","28-0.8MG","30","Select","Select",""],["","00536100901","FERROUS ","325MG","60","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":""}]}]}