{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAEVON MARSHALL","gend":0,"add":"26523 W PRINCE EDWARD HWY","city":"RICE","state":"VA","zip":"23966-9998","dob":"2004-07-30","age":"","mstatus":"","insh":"20031549*01","cliId":"","pno":8043063284,"cno":8043063284,"email":"","ename":"","eno":"","pphy":"DIONISIO, TERESITA C MD","ppno":4343929438,"pcpadd":"502 BEECH ST,","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":"23901-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4343927630,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R15.9","Q64.32","Q87.89","Q79.2","Q64.12","Q42.3","Q76.49","R51.9","H52.7","T88.1XXA","N18.2","Z00.01","N13.70","Z68.52","NO DATA","V58.89","N13.30","N32.89","N28.89","Z00.121","M54.9","H10.45","Z87.448","J30.9","R43.8","R43.2","N39.0","R30.9","R10.31","R36.9"],"date":["2022-05-26","2022-11-30","2022-05-03","2022-05-03","2022-05-03","2022-05-03","2022-05-03","2022-05-02","2022-09-13","2021-06-03","2022-06-13","2022-09-13","2022-11-30","2022-09-13","2022-11-30","2021-06-07","2022-11-30","2022-11-30","2022-11-30","2021-09-27","2022-05-02","2022-02-14","2022-05-11","2023-06-06","2023-06-06","2023-06-06","2023-06-23","2023-06-23","2023-06-23","2023-06-23"],"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":[["","65862042005","SMZ\/TMP DS","TAB 800-160","30","Select","Select",""],["","55111033901","AMLOD\/BENAZP","CAP 5-10MG","30","Select","Select",""],["","43547035211","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","55111033901","AMLODIPINE BESYLATE-BENAZEPRIL","5 MG-10 MG","30","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","30","Select","Select",""],["","45802065087","LORATADINE","10 MG","30","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","30","Select","Select",""],["","43547035211","LISINOPRIL TAB","5MG","30","Select","Select",""],["","55111033901","AMLOD\/BENAZP CAP","5-10MG","30","Select","Select",""],["","70461032203","FLUCLVX QUAD INJ","2022-23","0","Select","Select",""],["","59267030402","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","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":""}]}]}