{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA   S NICHOLS","gend":1,"add":"PO BOX 157","city":"TASLEY","state":"VA","zip":"23441-9998","dob":"1988-12-05","age":"","mstatus":"","insh":"2089426*01","cliId":"","pno":"434\/221-3304","cno":"","email":"","ename":"","eno":"","pphy":"HALLS, ALBERT JOHN MD","ppno":"757\/787-7374","pcpadd":"20306 BADGER LANE","pcpcity":"ONLEY","pcpstate":"VA","pcpzip":23418,"pcpcounty":"","pcpid":"","pcpname":"EASTERN SHORE RURAL HEALTH SYSTEM INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/787-4573","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","L30.9","F32.9","Z23.","F43.10","F33.1","R00.0","Z92.29","F33.2","F42.8","M41.23","M54.2","Z30.430","F41.9","F33.0","N93.8","R03.0","G43.009","Z59.0","Z32.02","Z76.89","H61.21","H91.91","R35.0","F51.5","D64.9","Z30.09","G43.809","Z30.431","N93.9","R55.","F39.","Z39.1","K04.7","N39.0","Z71.89","T74.31XA","R42."],"date":["2021-06-01","2020-02-26","2021-06-01","2021-06-25","2021-01-26","2020-07-07","2021-03-26","2021-06-25","2019-05-02","2019-05-01","2019-04-16","2019-04-16","2019-10-31","2019-05-31","2019-05-31","2019-11-25","2019-05-10","2019-05-31","2019-05-31","2019-10-31","2019-01-25","2019-01-25","2019-01-25","2019-08-22","2019-09-20","2019-12-18","2019-09-26","2019-09-26","2019-12-18","2019-12-18","2019-12-18","2019-01-10","2019-02-22","2019-07-19","2019-07-19","2019-03-29","2019-05-02","2019-09-25"],"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":[["","62332002331","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","17478030512","OLOPATADINE","SOL 0.002","2","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","","PROPRANOLOL"," PROPRANOLOL ","90","Select","Select",""],["","69543038190","OLANZAPINE","TAB 5MG","30","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","","BUPROPN","TAB 150MG XL","","Select","Select",""],["","","ALA-CORT","CRE 0.01","","Select","Select",""],["","","HYDROCORT","CRE 0.01","","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":""}]}]}