{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARLA HAWKS","gend":1,"add":"22 POINTE OF VIEW ARCH","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1965-05-01","age":"","mstatus":"","insh":"2198041*01","cliId":"","pno":7575581170,"cno":7575581170,"email":"","ename":"","eno":"","pphy":"MASON, JESSICA A MD","ppno":7574845828,"pcpadd":"7185 HARBOUR TOWNE PKWY SUITE 206","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23435-9998","pcpcounty":"","pcpid":"","pcpname":"Internists Of Churchland","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574844933,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z11.52","R05.9","K76.0","NO DATA","B35.3","B35.1","M20.41","M20.42","M20.11","M20.12","M79.672","D45.","K59.09","Z20.828","J30.9","E66.01","R52.","R21.","Z68.41","D47.1","Z00.00","Z12.31","Z68.39","Z23.","Z68.38","R73.9","Z13.220","E66.9"],"date":["2023-01-06","2021-11-26","2023-05-19","2022-08-17","2022-10-13","2022-10-13","2022-09-15","2022-09-15","2022-09-15","2022-09-15","2022-09-15","2023-05-08","2023-05-08","2021-01-22","2021-07-13","2022-11-18","2021-08-13","2022-06-21","2021-08-13","2023-05-19","2022-06-21","2022-06-21","2022-06-21","2022-11-18","2022-11-18","2022-11-18","2023-05-19","2023-05-19"],"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":[["","00169452414","WEGOVY","2.4MG\/0.75","3","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","60","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00093321992","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","00713022580","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","68462019005","NAPROXEN","500 MG","60","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","00713063818","CICLOPIROX","CRE 0.0077","90","Select","Select",""],["","72888001201","CYCLOBENZAPRINE HCL","5 MG","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","31722072690","MONTELUKAST SODIUM","10 MG","90","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":""}]}]}