{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARLESSIO J PETTICOLAS","gend":0,"add":"1911 POWHATAN AVE","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1986-05-14","age":"","mstatus":"","insh":"20084443*01","cliId":"","pno":8045226441,"cno":8045226441,"email":"","ename":"","eno":"","pphy":"ENDE, MARK MD","ppno":8047338771,"pcpadd":"121 S MARKET ST,","pcpcity":"PETERSBURG","pcpstate":"VA","pcpzip":"23803-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047331017,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T14.91XA","M50.20","R45.89","M54.6","F43.12","R55.","R00.1","R25.1","W19.XXXA","F33.1","F31.12","F25.1","R10.30","R31.9","K92.1","R61.","R30.9","S01.81XA","G40.909","I10.","F17.200","V72.85","F31.2","F31.9","T14.90XA","K92.0","F31.32","T71.164A","F43.10","F33.2","NO DATA","V62.84","F31.5"],"date":["2023-01-19","2023-01-19","2023-01-19","2023-01-19","2022-09-09","2022-08-12","2022-08-13","2022-08-12","2022-08-12","2022-08-19","2023-09-15","2022-07-10","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-08-13","2022-08-13","2022-08-13","2022-08-13","2022-08-13","2022-08-17","2022-09-01","2023-01-19","2022-07-19","2022-12-07","2023-01-19","2022-07-07","2022-08-16","2023-01-19","2023-01-19","2023-09-05"],"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":[["","68001018008","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","29300011105","LAMOTRIGINE","TAB 25MG","30","Select","Select",""],["","68180035202","SERTRALINE","TAB 50MG","30","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","65862024608","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","00143983601","PENICILLIN V POTASSIUM","500 MG","28","Select","Select",""],["","55111053201","DIVALPROEX SODIUM","125 MG","24","Select","Select",""],["","00054350049","LIDOCAINE HCL VISCOUS","2 %","200","Select","Select",""],["","69097083412","SERTRALINE HCL","50 MG","12","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 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":""}]}]}