{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LETICIA  I RIVERA","gend":1,"add":"14325 WESTWAY LN APT 3","city":"WOODBRIDGE","state":"VA","zip":22193,"dob":"1988-09-18","age":"","mstatus":"","insh":"2109890*01","cliId":"","pno":"703\/593-3703","cno":"571\/329-9078","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"703\/680-7950","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":22193,"pcpcounty":"","pcpid":"","pcpname":"GREATER PRINCE WILLIAM AREA COMMUNITY HEALTH CENTER INC","plan":"OHP","program":"Medicaid","lob":"M4","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"703\/680-7953","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R29.818","R53.1","G45.9","R20.2","G43.709","R20.0","S83.002A","Z23.","Z20.828","I50.9","I67.1","E11.65","M79.2","R29.898","J06.9","G43.909","Z30.430","I63.032","G95.0","Z68.34","R29.702","R29.810","E66.9","M48.02","E78.00","V58.69","Z59.6","Z91.128","Z90.49","Z79.84","Z79.899","E55.9","M25.562","M79.605","G89.29","Z98.890","R87.612","E78.5"],"date":["2020-03-08","2020-03-08","2020-03-07","2020-03-08","2020-04-27","2020-04-27","2020-05-26","2021-05-18","2020-11-19","2020-03-05","2020-03-05","2022-07-13","2020-03-08","2020-08-04","2020-03-05","2020-03-06","2021-07-21","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2022-07-13","2020-08-10","2020-08-10","2020-08-10","2022-10-24","2022-10-24","2022-07-13"],"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":[["","53885001110","ONETOUCH","MIS PLUS 30G","100","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","6","Select","Select",""],["","","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","57599080300","FREESTY","MIS 2 READER","1","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","15","Select","Select",""],["","","METFORMIN","TAB 850MG","","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","00052433001","NEXPLANON","IMP 68MG","1","Select","Select",""],["","50419042301","MIRENA","IUD SYSTEM","1","Select","Select",""],["","00548570100","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","JANUVIA","TAB 50MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","PREDNISONE","TAB 10MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-300MG","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","20","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":""}]}]}