{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY   M DASILVA","gend":1,"add":"2350 CHESDIN LAKE ROAD","city":"CHURCH ROAD","state":"VA","zip":"23833-9998","dob":"1993-06-06","age":"","mstatus":"","insh":"1005765*01","cliId":"","pno":"804\/420-5927","cno":"","email":"","ename":"","eno":"","pphy":"JIMA, BOGALE MD","ppno":"804\/276-6900","pcpadd":"10130 HULL STREET","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":"23112","pcpcounty":"","pcpid":"","pcpname":"Physicians of Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/276-1366","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.30","K59.09","J02.9","Z72.89","Z86.19","K21.9","R53.82","F43.10","B34.9","R51.","R10.9","Z30.432","Z30.011","M79.81","Z48.00","F41.8","T83.9XXA","F41.9","G43.009","M25.551","F90.2","F41.0","R10.31","R10.13","R10.11","R10.33","Z01.419","NO DATA","Z30.44","Z30.014","Z11.3","L76.34","J06.9","Z87.891","Z20.828","Z32.02","M96.840","Z30.430","Z30.431","Z09.","Z87.828","T78.1XXA","Z20.822","H83.09"],"date":["2020-03-30","2020-04-28","2020-03-30","2020-03-30","2020-03-30","2020-03-30","2020-03-30","2021-10-18","2021-12-28","2020-03-18","2020-03-18","2020-05-11","2020-05-11","2021-03-11","2021-03-15","2021-12-03","2020-03-03","2020-07-28","2020-04-28","2020-04-28","2020-09-14","2020-09-14","2020-10-08","2020-12-25","2020-12-25","2020-12-25","2021-12-03","2021-12-03","2021-12-03","2020-01-21","2020-01-21","2021-02-18","2021-09-06","2021-09-06","2021-09-06","2021-12-03","2021-03-15","2020-02-11","2020-02-11","2020-07-10","2020-07-28","2020-07-28","2021-08-28","2021-12-28"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65862039110","ONDANSETRON","TAB 8MG ODT","21","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","55","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","90","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00093767902","ETONOGESTREL","MIS ETHY EST","1","Select","Select",""],["","23155050001","HYDROXYZ","TAB 10MG","60","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","TAB ","12","Select","Select",""],["","00536129701","MECLIZINE","TAB 12.5MG","10","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","30","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","14","Select","Select",""],["","68180013501","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""]]}},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}