{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONISHA HAWKINS","gend":1,"add":"3808 GREENWOOD DR","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1982-11-28","age":"","mstatus":"","insh":"1401361*01","cliId":"","pno":"804\/779-9439","cno":"","email":"","ename":"","eno":"","pphy":"ALI, SABINA MD","ppno":"804\/673-2814","pcpadd":"SUITE 102 5855 BREMO ROAD","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23226,"pcpcounty":"","pcpid":"","pcpname":"MONUMENT INTERNAL MEDICINE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/673-2873","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","N18.3","E66.9","E55.9","Z68.41","F33.0","F41.9","E66.01","R10.84","G44.309","Z68.42","D69.6","R10.30","N18.2","Z90.5","J30.1","Z23.","R30.0","R31.29","E78.00","F41.0","R73.03","F32.1","S09.90XA","S16.1XXA","Z87.891","Z79.899","M54.2"],"date":["2020-07-27","2020-07-27","2020-07-27","2020-08-05","2020-07-27","2020-07-27","2020-07-27","2019-11-26","2019-05-01","2019-10-22","2019-10-22","2020-07-27","2019-05-08","2019-10-10","2019-05-22","2019-05-22","2019-10-10","2019-10-10","2019-10-10","2019-10-10","2020-08-05","2020-07-27","2020-08-05","2019-10-16","2019-10-16","2019-10-16","2019-10-16","2019-10-16"],"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":[["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","","VENLAFAXINE","CAP 37.5 ER","","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":""}]}]}