{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KRISTIN   I ESCOLASTICO","gend":1,"add":"5509 SUSQUEHANNA DR","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1980-02-24","age":"","mstatus":"","insh":"20064078*01","cliId":"","pno":"757\/818-0112","cno":"757\/818-0112","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L72.11","L71.9","D23.9","L81.4","D22.9","D18.00","Z12.83","Z71.9","R10.31","R31.9","N30.00","F90.0","F41.1","N39.0","Z00.00","I10.","N92.1"],"date":["2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-02-26","2020-02-04","2020-02-04","2020-03-14","2020-03-11","2020-03-11","2020-03-14","2020-03-06","2020-03-06","2020-03-06"],"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":[["","59417010610","VYVANSE","CAP 60MG","60","Select","Select",""],["","43547035410","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","62332054804","CLOBETASOL","SHA 0.0005","118","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","4","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","30","Select","Select",""],["","00378427593","VALACYCLOVIR","TAB 500MG","60","Select","Select",""],["","00642007530","SELECT-OB+","PAK DHA","60","Select","Select",""],["","00378400305","ALPRAZOLAM","TAB 0.5MG","30","Select","Select",""],["","62037059905","CARTIA","CAP 240\/24HR","30","Select","Select",""],["","16714065202","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","11822504860","RA","TAB 24 HOUR","30","Select","Select",""],["","51293081101","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","72143021160","DOXYCYCL","TAB 50MG","60","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","68462074617","ACYCLOVIR","OIN 0.05","15","Select","Select",""],["","69918030130","TRANEX","TAB 650MG","90","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":""}]}]}