{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ADIA LORENZO","gend":1,"add":"108 E HOWARD ST","city":"HAMPTON","state":"VA","zip":"23663-9998","dob":"2000-12-15","age":"","mstatus":"","insh":"1250675*01","cliId":"","pno":"757\/284-6358","cno":"","email":"","ename":"","eno":"","pphy":"HOLTZ, KRISTEN E DO","ppno":"757\/827-1940","pcpadd":"3401 W MERCURY BLVD","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"RIVERSIDE PHYSICIAN SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/596-4715","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C56.1","D39.10","D27.9","D50.9","Z85.43","L73.2","Z92.21","Z08.","H93.293","T45.1X1A","B34.9","R05.9","Z20.822","R09.81","R53.81","F90.9","F43.10","Z79.899","Z91.048","R09.89","D39.11","Z98.890","H93.19","V58.89"],"date":["2020-05-18","2020-10-29","2020-10-29","2021-10-25","2021-10-25","2020-11-20","2021-10-25","2021-04-29","2020-05-28","2020-05-28","2021-12-04","2021-12-04","2021-12-04","2021-12-04","2021-12-04","2021-12-04","2021-12-04","2021-12-04","2021-12-04","2021-12-04","2019-02-27","2019-09-04","2019-02-27","2019-02-27"],"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":[["","00904759080","FEROSUL","TAB 325MG","25","Select","Select",""],["","","CLINDAMYCIN","SOL 0.01","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","11917009215","FERROUS","TAB 325MG","25","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","20","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":""}]}]}