{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIO  F RAINEY","gend":0,"add":"4401 ERICCSON DR SALVATION ARMY","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1965-01-12","age":"","mstatus":"","insh":"2169119*01","cliId":"","pno":7575286612,"cno":7575286612,"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":"M4","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.","B18.2","I10.","F33.3","Z23.","F33.1","F41.1","S82.892A","Z12.11","Z72.0","K08.9","S82.52XA","S82.55XA","Z21.","S99.912A","J06.9","V54.16"],"date":["2022-12-19","2022-12-19","2022-12-19","2022-07-10","2022-12-19","2023-04-16","2023-04-10","2022-07-11","2021-01-04","2021-10-18","2021-10-18","2022-06-29","2022-06-29","2022-06-29","2022-06-29","2021-07-02","2022-07-13"],"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":[["","00536136206","NICOTINE POL","GUM 2MG","100","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00591333119","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","43547042409","LOSARTAN\/HCT","TAB 100-25","30","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","16714029902","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","18","Select","Select",""],["","65162046550","IBUPROFEN","TAB 600MG","60","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00591333119","BUPROPION XL","150 MG","30","Select","Select",""],["","43547042409","LOSARTAN-HYDROCHLOROTHIAZIDE","100MG-25MG","30","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00536136206","NICOTINE GUM","2 MG","200","Select","Select",""],["","43547042409","LOSARTAN\/HCT TAB","100-25","30","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","00536136206","NICOTINE POL GUM","2MG","200","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00591333119","BUPROPN HCL TAB","150MG XL","30","Select","Select",""],["","00093310953","AMOXICILLIN CAP","500MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP TAB","5-325MG","18","Select","Select",""],["","65162046550","IBUPROFEN TAB","600MG","60","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","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":""}]}]}