{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANA   MARIE D DIGA","gend":1,"add":"1363 IVYWOOD RD APT 213","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1978-08-17","age":"","mstatus":"","insh":"1852330*01","cliId":"","pno":"757\/339-4267","cno":"757\/339-4267","email":"","ename":"","eno":"","pphy":"TANNOUS, GEORGE MD","ppno":"757\/305-1797","pcpadd":"828 HEALTHY WAY SUITE 220","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/309-4715","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L72.3","L08.9","L02.212","Z48.00","Z88.2","Z20.828","U07.1","Z48.817","E11.9","Z79.4","Z51.89","H04.123","H52.01","H52.223","H52.4","D17.1","E11.69","E78.2","K76.0","R74.8","L02.91","B35.6","I47.1","R06.02","R42."],"date":["2020-02-27","2020-02-27","2020-03-09","2020-02-29","2020-03-09","2021-04-12","2022-05-02","2020-03-09","2020-03-13","2020-03-09","2020-03-09","2022-04-19","2022-04-19","2022-04-19","2022-04-19","2020-02-01","2020-02-01","2020-03-13","2020-03-13","2020-03-13","2020-03-13","2020-03-13","2020-03-11","2020-03-11","2020-03-11"],"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":[["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","20","Select","Select",""],["","29300012410","MELOXICAM","TAB 7.5MG","20","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","30","Select","Select",""],["","31722088390","ROSUVASTATIN","TAB 10MG","30","Select","Select",""],["","51224000760","METFORMIN","TAB 500MG ER","120","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","18","Select","Select",""],["","00472037945","CLOTRIM\/BETA","CRE DIPROP","45","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":""}]}]}