{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDRE   F MATOS","gend":0,"add":"2603 KILGORE ST","city":"HAYMARKET","state":"VA","zip":"20169-9998","dob":"1988-10-04","age":"","mstatus":"","insh":"2266072*01","cliId":"","pno":"571\/248-6981","cno":"571\/248-6981","email":"","ename":"","eno":"","pphy":"SCRIPPS, MATTHEW DO","ppno":"571\/248-4620","pcpadd":"13575 HEATHCOTE BLVD SUITE 210","pcpcity":"GAINESVILLE","pcpstate":"VA","pcpzip":20155,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"571\/248-4374","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","M54.10","F11.99","Z03.818","F41.1","F33.9","F51.01","G90.09","G89.29","F32.9","G47.9","Z11.3","I10.","F11.21","F29.","F19.10","F43.10","F33.1","F14.20","S69.90XA","Z00.00","M79.604","F32.1","NO DATA","S81.811A","Z23.","Z91.013","S81.011A","S82.831A","R39.11","J45.20","S93.491A","S93.421A","S99.911A"],"date":["2021-10-20","2020-09-16","2020-11-29","2021-01-13","2021-03-01","2021-03-01","2021-03-01","2021-03-01","2021-10-20","2021-03-09","2021-03-09","2021-03-09","2021-10-20","2022-11-21","2020-10-30","2020-05-18","2021-10-20","2021-03-23","2021-03-23","2020-10-22","2021-10-20","2021-10-20","2021-10-20","2021-10-20","2022-09-26","2022-09-26","2022-09-26","2022-09-26","2020-11-26","2021-01-24","2021-01-24","2020-11-15","2020-11-20","2020-11-26"],"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":[["","82607066026","FLOWFLEX","KIT TEST","2","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","90","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","30","Select","Select",""],["","87701040813","MELATONIN","TAB 3MG","90","Select","Select",""],["","16729014717","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","45963055650","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","60","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","14","Select","Select",""],["","50428050854","CVS","PAK ","60","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","71930004512","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","00168020260","CLINDAMYCIN","GEL 0.01","60","Select","Select",""],["","53489012002","DOXYCYCL","TAB 100MG","56","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","30","Select","Select",""],["","51672404806","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","00135019402","NICODERM","DIS 21MG\/24H","30","Select","Select",""],["","68382080605","TRAZODONE","TAB 100MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","15","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":""}]}]}