{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CELIA   M SABILLON","gend":1,"add":"7947 THOMPSON RD LOT 4","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1970-12-22","age":"","mstatus":"","insh":"1237157*01","cliId":"","pno":"757\/401-3573","cno":"757\/401-3573","email":"","ename":"","eno":"","pphy":"BONEY, ARON MD","ppno":"757\/278-2240","pcpadd":"155 KINGSLEY LN STE 400","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23505,"pcpcounty":"","pcpid":"","pcpname":"DEPAUL MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/489-6469","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K91.2","Z98.84","D50.9","E66.9","Z68.30","N92.0","M25.561","M25.562","Z23.","M17.12","E55.9","D50.8","D75.89","R53.82","L30.4","R42.","Z68.33","E88.81","B34.9","M19.90","M15.0","I73.00","N92.4","Z01.419","Z68.32","Z20.822","Z00.00","Z12.11","M19.049","B35.1","L30.9","Z68.31","Z32.02","N92.1"],"date":["2020-04-01","2020-05-20","2020-06-30","2022-01-28","2020-04-01","2020-06-11","2021-03-26","2021-05-05","2022-10-17","2022-10-17","2021-02-02","2022-10-17","2021-06-22","2021-06-22","2021-06-22","2022-01-28","2022-10-17","2022-02-06","2020-02-07","2020-05-20","2020-05-19","2020-05-19","2020-06-30","2022-11-01","2021-02-05","2022-07-22","2022-10-17","2022-10-17","2022-10-17","2022-10-17","2021-02-05","2020-02-18","2020-06-11","2020-06-11"],"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":[]},{"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":[["","16571066101","MECLIZINE","TAB 25MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","30","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","30","Select","Select",""],["","68462079817","TRIAMCINOLON","OIN 0.005","30","Select","Select",""],["","51672128902","NYSTATIN","CRE 100000","30","Select","Select",""],["","00067815202","VOLTAREN","GEL 0.01","100","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","100","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","45802086866","POLYETH","POW 3350 NF","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}