{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DWIGHT   A MITCHELL","gend":0,"add":"815 KILBY AVE APT 204","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1986-10-09","age":"","mstatus":"","insh":"20064832*01","cliId":"","pno":"757\/374-6468","cno":"757\/374-6468","email":"","ename":"","eno":"","pphy":"YUNAS, MOHAMMAD MD","ppno":"393-6595","pcpadd":"3003 HIGH ST","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/393-9584","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","R11.2","Z20.822","R06.7","Z88.0","Z02.89","F20.9","S93.401A","M25.471","Z00.00","B34.9","Z20.828","S93.491A","R60.9","M25.571","R68.83","S99.911A","H16.133"],"date":["2020-06-12","2021-04-13","2022-04-19","2022-04-19","2022-09-26","2022-09-26","2022-09-27","2021-10-18","2021-10-18","2022-09-26","2020-09-28","2020-09-28","2021-10-22","2021-10-22","2021-10-22","2021-09-10","2021-10-18","2021-11-12"],"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":[]},{"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":[["","27241000306","RISPERIDONE","TAB 0.5MG","60","Select","Select",""],["","00185111160","BUPROPION","TAB 200MG SR","60","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","20","Select","Select",""],["","17478007035","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","54092039101","ADDERALL","CAP 30MG","30","Select","Select",""],["","29300014801","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","00378230201","PRAZOSIN","CAP 2MG","30","Select","Select",""],["","00406889401","AMPHET\/DEXTR","TAB 30MG","10","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","60","Select","Select",""],["","78112001103","CHLORASEPTIC","SPR 0.014","177","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","63824071016","CEPACOL","LOZ 15-3.6MG","32","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":""}]}]}