{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EUNICIA WILKINS","gend":1,"add":"1313 CYPRESS PL","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1993-11-22","age":"","mstatus":"","insh":"5265169*01","cliId":"","pno":"757\/572-8707","cno":"","email":"","ename":"","eno":"","pphy":"GARNER, KELSEY J PA","ppno":"757\/842-4100","pcpadd":"725 VOLVO PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320","pcpcounty":"","pcpid":"","pcpname":"Nowcare Volvo","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/410-3562","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.0","M54.5","F90.0","F43.23","J06.9","R06.2","Z11.52","Z11.3","N93.9","N92.6","Z30.430","F31.81","F41.1","E28.2","J35.1","R06.83","J35.01","J35.8","M79.671","S86.011A","F43.10","M47.816","R26.9","M25.60","Z30.431","N92.0","N83.201","N81.6","R10.2","S33.5XXA","Z20.828","Z20.2","J02.9"],"date":["2020-08-03","2020-08-03","2021-12-29","2021-09-01","2021-09-16","2021-09-16","2021-09-16","2021-11-02","2021-11-02","2021-11-02","2021-11-18","2021-12-29","2021-12-29","2021-12-09","2020-01-14","2020-01-14","2020-01-14","2020-01-14","2021-09-10","2021-09-10","2021-10-05","2020-12-10","2020-12-10","2020-12-10","2021-11-08","2021-11-08","2021-12-29","2021-12-29","2021-12-29","2020-11-24","2020-12-13","2020-08-04","2021-03-17"],"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":[["","13668033201","TRAZODONE","TAB 150MG","30","Select","Select",""],["","51672413101","LAMOTRIGINE","TAB 100MG","30","Select","Select",""],["","16729013600","CLONAZEPAM","TAB 0.5MG","90","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","45","Select","Select",""],["","59310058020","PROAIR","AER ","1","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","10","Select","Select",""],["","51862025801","NEXTSTELLIS","TAB 3-14.2MG","112","Select","Select",""],["","57664037708","TRAMADOL","TAB 50MG","42","Select","Select",""],["","31722017401","METHYLPHENID","TAB 10MG","60","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00378018201","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","00228306311","AMPHET\/DEXTR","CAP 15MG ER","30","Select","Select",""],["","54092038501","ADDERALL","CAP 15MG","30","Select","Select",""],["","65862019430","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","50419042301","MIRENA","IUD SYSTEM","1","Select","Select",""],["","69238134201","ETODOLAC","TAB 400MG","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":""}]}]}