{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARKITA   M HINES","gend":1,"add":"1105 COMMONWEALTH PL","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1987-01-31","age":"","mstatus":"","insh":"7885792*01","cliId":"","pno":"757\/202-6815","cno":"","email":"","ename":"","eno":"","pphy":"BURFOOT, KEISHA L MD","ppno":"757\/395-4455","pcpadd":"STE 340 6161 KEMPSVILLE CIR","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"ELITE WOMENS CARE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/233-1792","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","B34.9","M25.571","K59.00","R10.84","Z72.0","Z00.00","I10.","D50.9","R10.0","R10.2","NO DATA","S80.861A","S20.462A","D64.9","M79.671","S93.621A","R60.0","J20.9","T59.891A","J18.9","F17.210","F31.81","R53.83","F32.9","Z88.5","Z91.013","Z87.42","N93.9","A09.","R82.71","N80.9","K08.89"],"date":["2021-02-12","2021-02-12","2021-07-05","2021-11-06","2021-11-06","2021-11-06","2020-07-27","2021-12-29","2020-07-27","2021-11-06","2021-12-29","2021-12-29","2020-07-06","2020-07-06","2020-07-06","2021-07-14","2021-07-14","2021-07-14","2020-12-17","2021-04-01","2021-04-01","2021-11-06","2020-07-14","2020-07-22","2020-02-12","2021-12-29","2021-12-29","2021-12-29","2021-12-29","2020-08-23","2020-08-23","2019-01-18","2019-05-26"],"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":{"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":[["","00904672080","ACETAMIN","TAB 500MG","30","Select","Select",""],["","43386031214","GAVILAX","POW ","510","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","18","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","","LATUDA","TAB 20MG","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","","FERROUS","TAB 325MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","","BISOPRL\/HCTZ","TAB 5-6.25MG","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","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":""}]}]}