{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEONNA   M WHITLEY","gend":1,"add":"3312 ZURICH ARCH","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"2004-08-04","age":"","mstatus":"","insh":"9494227*01","cliId":"","pno":"757\/304-2750","cno":"468-4245","email":"","ename":"","eno":"","pphy":"LI, WENHONG MD","ppno":"757\/689-8430","pcpadd":"SUITE 100 1925 GLENN MITCHELL DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23456","pcpcounty":"","pcpid":"","pcpname":"Princess Anne Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/689-8435","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["V62.84","F17.210","Z20.828","NO DATA","F31.60","V62.85","Z78.1","Z72.51","Z91.5","Z86.19","Z81.8","F43.25","F13.20","F31.0","F12.20","F31.9","F32.9","Z74.3","F31.10","Z30.011","F13.10","Z91.89","Z11.3","Z30.41","Z20.2","Z91.14","A54.9","S51.812A","S71.111A","F41.9","N89.8","V54.12","F31.4","A74.9","M79.641","N92.6","Z13.6"],"date":["2020-12-22","2020-09-29","2021-08-11","2020-12-18","2020-12-21","2020-12-22","2020-12-17","2020-12-17","2021-09-27","2020-12-17","2020-12-17","2020-12-20","2020-12-21","2020-12-31","2020-12-31","2021-12-23","2021-12-23","2020-12-22","2020-12-26","2020-05-14","2020-12-22","2020-12-22","2021-11-08","2021-01-07","2021-11-08","2020-05-28","2020-10-07","2020-12-17","2020-12-17","2020-12-17","2020-09-08","2020-10-08","2020-12-20","2020-09-15","2020-09-15","2020-11-06","2020-12-18"],"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":[["","68180044701","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","68180084473","KURVELO","TAB 0.15\/30","28","Select","Select",""],["","62756043088","LITHIUM","TAB 300MG","60","Select","Select",""],["","00378655053","LEVONOR\/ETHI","TAB ESTRADIO","28","Select","Select",""],["","00093550456","OLANZA\/FLUOX","CAP 6-25MG","30","Select","Select",""],["","43598016530","OLANZAPINE","TAB 7.5MG","30","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","55111025660","ZIPRASIDONE","CAP 20MG","30","Select","Select",""],["","29300011101","LAMOTRIGINE","TAB 25MG","42","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","62332002431","FLUOXETINE","CAP 40MG","30","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":""}]}]}