{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEAZIA OWENS","gend":1,"add":"2351 TERMINAL AVE APT 1","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"2002-09-04","age":"","mstatus":"","insh":"8133174*01","cliId":"","pno":"757\/283-8582","cno":"757\/283-8582","email":"","ename":"","eno":"","pphy":"MOTLEY, VICKIE MD","ppno":"757\/826-6889","pcpadd":"STE D 2200 EXECUTIVE DR","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":350384,"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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.12","R06.89","O99.343","O99.324","Z37.0","F39.","F12.90","O76.","O36.8930","O35.8XX0","O13.3","O42.92","O70.0","Z3A.38","Z34.03","Z39.1","G44.219","I10.","F33.8","Z34.83","Z3A.28","Z20.822","Z11.2","Z3A.37","Z11.8","Z13.32","O26.90","N92.5","V23.87","Z32.01","O98.513","U07.1","NO DATA","R04.2","Z3A.36","O13.4","M20.12","L60.0","O42.02","O10.02","L20.82","Z87.59","B34.9","F90.9","Z79.899","J30.2","J02.9","F33.1"],"date":["2021-02-23","2021-01-21","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-23","2021-02-25","2021-03-05","2021-03-05","2020-09-22","2020-12-28","2020-12-28","2021-07-27","2021-02-12","2021-02-12","2021-02-12","2021-02-12","2021-02-23","2020-07-30","2020-07-30","2020-07-30","2021-01-21","2021-01-21","2021-01-21","2021-01-21","2021-01-21","2021-02-23","2021-04-21","2021-04-21","2021-02-23","2021-02-23","2021-06-29","2021-06-29","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-07-27","2021-06-17"],"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":[["","68462015713","ONDANSETRON ","4MG ODT","24","Select","Select",""],["","00904759180","FEROSUL ","325MG","60","Select","Select",""],["","00536406301","CL ","28-0.8MG","30","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","12","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","21","Select","Select",""],["","45802006435","TRIAMCINOLON ","0.10%","15","Select","Select",""],["","11917009215","FERROUS ","325MG","30","Select","Select",""],["","07610010418","PRENATAL ","28-0.8MG","30","Select","Select",""],["","00536122522","ANTACID ","750MG","180","Select","Select",""],["","00536106210","STOOL ","100MG","60","Select","Select",""],["","00677019101","DOCUSATE ","100MG","60","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","60","Select","Select",""],["","45802005935","NYSTATIN ","100000","30","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","",""],["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":""}]}]}