{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELLE   A PEDREIRA","gend":1,"add":"9285 E MASON CREEK RD APT B","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1985-06-20","age":"","mstatus":"","insh":"5382521*01","cliId":"","pno":"757\/589-4350","cno":"","email":"","ename":"","eno":"","pphy":"SANTACRUZ, NESTOR D MD","ppno":"757\/583-2181","pcpadd":"2203 E LITTLE CREEK RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":"","pcpname":"Roosevelt Family Practice","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/480-6482","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.9","G25.81","G43.909","F41.1","R07.9","Z39.1","Z34.82","Z34.83","M25.562","K05.10","M54.5","F34.1","Z72.0","Z34.03","Z3A.31","Z23.","Z33.1","Z39.2","R87.810","Z13.32","Z20.822","L30.0","Z28.21","Z71.9","O42.913","O10.92","Z37.0","O99.334","F17.210","Z3A.36","Z20.828","Z34.90","R21.","Z79.899","O13.3","Z3A.34","O09.523","O80.","M54.89"],"date":["2021-08-03","2021-07-21","2021-07-21","2021-08-03","2019-12-28","2020-12-08","2020-12-08","2020-12-08","2021-08-30","2021-08-03","2020-01-06","2021-08-03","2021-08-03","2020-11-20","2020-11-20","2020-11-20","2020-11-20","2021-02-08","2021-02-08","2021-02-08","2021-10-10","2019-08-01","2019-08-01","2019-08-01","2020-12-26","2020-12-25","2020-12-26","2020-12-25","2020-12-25","2020-12-26","2020-12-25","2020-12-25","2019-07-02","2019-07-02","2020-12-26","2020-12-14","2020-12-26","2020-12-26","2020-10-22"],"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":[["","","ALLERGY"," ALLERGY ","20","Select","Select",""],["","","CHANTIX"," CHANTIX ","56","Select","Select",""],["","","TERBINAFINE"," TERBINAFINE ","14","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","","FLUOXETINE"," FLUOXETINE ","30","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","21","Select","Select",""],["","","LIDOCAINE"," LIDOCAINE ","30","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","20","Select","Select",""],["","","RA"," RA ","20","Select","Select",""],["","","CYCLOBENZAPR"," CYCLOBENZAPR ","12","Select","Select",""],["","","MICONAZOLE","CRE 0.02","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","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":""}]}]}