{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAISHA YOUNG","gend":1,"add":"1708 BIRCH TRAIL CIR APT X","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"2004-04-25","age":"","mstatus":"","insh":"2315414*01","cliId":"","pno":"757\/907-0779","cno":"","email":"","ename":"","eno":"","pphy":"MARTIN, ALLISON NP","ppno":"757\/548-0076","pcpadd":"725 VOLVO PKWY SUITE 100","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"BAYVIEW PHYSICIAN SERVICES PC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-1652","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.0","M25.561","M25.361","Z30.8","R10.9","Z20.822","Z30.431","Z11.52","L08.9","Z00.00","Q60.0","Z30.02","H61.22","Z01.818","M77.01","R93.421","Z90.5","H66.90","Z30.40","G89.29","M25.562","N92.6"],"date":["2022-04-13","2022-11-20","2022-03-03","2021-11-19","2022-06-07","2022-10-04","2021-12-28","2022-10-05","2021-10-02","2021-10-14","2021-10-14","2021-10-14","2022-10-16","2021-11-09","2022-01-09","2022-06-08","2022-06-08","2022-10-16","2022-03-11","2022-11-20","2022-11-20","2022-11-20"],"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":[["","00430042014","LO","TAB 40452","84","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","10","Select","Select",""],["","68382005001","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","11822046713","PAIN","TAB 325MG","20","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","56","Select","Select",""],["","57896010201","ACETAMINOPHE","TAB 325MG","20","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","4","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","20","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","4","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":""}]}]}