{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EBONY RAMSEY","gend":1,"add":"824 MALLSIDE FOREST CTS APT 303","city":"CHARLOTTESVILLE","state":"VA","zip":"22901-9998","dob":"1990-12-31","age":"","mstatus":"","insh":"2192302*01","cliId":"","pno":4348065636,"cno":4348065636,"email":"","ename":"","eno":"","pphy":"MORIKAWA, MASAHIRO MD","ppno":4349245348,"pcpadd":"1221 LEE STREET FL 1,","pcpcity":"CHARLOTTESVILLE","pcpstate":"VA","pcpzip":"22908-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4349248798,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z71.3","E66.9","R87.810","L73.2","Z01.818","E66.01","Z68.41","Z98.84","K91.2","Z68.39","Z01.419","N89.8","Z87.42","E28.2","Z11.59","N87.1","R87.618","Z23.","O02.1","G47.30","G47.33","Z20.822","O04.6","R10.2","F54.","R79.0","E55.9","E53.8","Z87.410","Z30.41","L83.","Z12.4","Z11.3","N76.0","Z30.09","O03.9","N93.9","R87.613","M54.9","Z34.81","T43.222A","F32.2","V62.84"],"date":["2021-08-26","2021-01-21","2021-11-30","2022-03-21","2021-10-22","2022-02-01","2021-11-16","2023-03-06","2022-11-22","2022-02-01","2022-11-02","2022-11-02","2022-11-02","2021-06-16","2021-04-26","2021-11-30","2021-11-30","2021-11-30","2022-02-28","2021-08-13","2021-08-13","2023-07-10","2023-03-06","2023-03-06","2021-07-09","2021-05-24","2022-05-10","2021-08-26","2021-10-05","2021-10-05","2021-10-25","2021-01-06","2021-01-06","2022-03-21","2022-03-21","2022-03-21","2023-03-06","2021-04-06","2021-10-25","2022-03-21","2023-07-10","2023-07-11","2023-07-10"],"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":[["","55111014512","FLUCONAZOLE","150 MG","2","Select","Select",""],["","00555901658","SPRINTEC 28","TAB 28 DAY","84","Select","Select",""],["","00168020360","CLINDAMYCIN","LOT 0.01","60","Select","Select",""],["","42806054701","VITAMIN D","CAP 1.25MG","13","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","80777027399","MODERNA COVID (","12Y UP)VAC(EUA) 100MCG\/0.5","0.5","Select","Select",""],["","00168020360","CLINDAMYCIN LOT","1%","60","Select","Select",""],["","42806054701","VITAMIN D CAP","1.25MG","4","Select","Select",""],["","00555901658","SPRINTEC","28 TAB 28 DAY","84","Select","Select",""],["","55111014512","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","14","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":""}]}]}