{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDRE AUSTIN","gend":0,"add":"615 45TH ST","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1962-11-01","age":"","mstatus":"","insh":"20074649*01","cliId":"","pno":7576604092,"cno":7576604092,"email":"","ename":"","eno":"","pphy":"WEBSTER, ELIZABETH MD","ppno":7579755200,"pcpadd":"7401 WARWICK BLVD,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23607-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572230829,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B20.","E78.5","Z21.","F10.20","Z23.","Z20.822","B37.0","F10.10","R06.6","F20.9","S22.42XA","S01.01XA","S39.91XA","R07.81","R91.1"],"date":["2022-11-10","2022-10-13","2022-10-13","2021-05-17","2021-08-27","2021-08-02","2021-10-07","2022-11-10","2022-11-10","2022-12-30","2023-07-14","2023-07-14","2023-07-14","2023-07-14","2023-07-14"],"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":[["","59676056630","PREZISTA","TAB 800MG","30","Select","Select",""],["","00536123441","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","60505257809","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","61958190101","GENVOYA","TAB ","30","Select","Select",""],["","16714069211","FLUCONAZOLE","TAB 150MG","14","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","12","Select","Select",""],["","00121086816","NYSTATIN","SUS 100000","224","Select","Select",""],["","00536100410","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","70677013202","SM ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","59676080030","SYMTUZA","800-150 MG","30","Select","Select",""],["","60505257809","ATORVASTATIN CALCIUM","10 MG","30","Select","Select",""],["","70677016302","ASPIRIN EC","81 MG","30","Select","Select",""],["","70677013202","SM ASPIRIN TAB","81MG EC","30","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","12","Select","Select",""],["","59676056630","PREZISTA TAB","800MG","30","Select","Select",""],["","61958190101","GENVOYA TAB","","30","Select","Select",""],["","16714017301","ATORVASTATIN TAB","10MG","30","Select","Select",""],["","00536123441","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","59676080030","SYMTUZA TAB","","30","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","12","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":""}]}]}