{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JUSTIN SMITH","gend":0,"add":"5848 ECHINGHAM DR","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1982-11-09","age":"","mstatus":"","insh":"20003098*01","cliId":"","pno":"757\/227-3900","cno":"","email":"","ename":"","eno":"","pphy":"GRANT JR, THOMAS R MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE STE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/446-5196","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.9","F32.9","R35.0","N32.81","G47.8","F43.29","R49.0","N52.9","NO DATA","Z72.820","Z12.11","H61.20","L29.0","R14.3","R41.3","C71.9","R51.0","R53.82","R53.81","Z85.841","G31.84","Z85.528","H51.9","L98.9"],"date":["2021-12-14","2020-10-14","2021-12-14","2020-02-07","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2021-12-14","2021-12-14","2020-06-15","2020-06-15","2021-03-22","2021-03-22","2019-02-06","2019-02-06","2020-10-14","2020-10-14","2020-10-14","2020-10-14","2019-02-12","2019-07-12","2019-07-12","2019-07-12"],"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":[["","00832003800","OXYBUTYNIN","TAB 5MG","90","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","00536101901","GAS","CHW 80MG","120","Select","Select",""],["","65862052730","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","","DEBROX","SOL 6.5% OT","","Select","Select",""],["","","TOLTERODINE","CAP 4MG ER","","Select","Select",""],["","","DULOXETINE","CAP 60MG","","Select","Select",""],["","","TROSPIUM","CAP 60MG 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":""}]}]}