{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRISTAN COURNEDE","gend":0,"add":"4325 CHAMBERLAYNE AVE APT 21","city":"RICHMOND","state":"VA","zip":"23227-9998","dob":"1986-04-20","age":"","mstatus":"","insh":"2356028*01","cliId":"","pno":7575073119,"cno":7575073119,"email":"","ename":"","eno":"","pphy":"DOMAH, NAU DEAVIN MD","ppno":8043298510,"pcpadd":"2421 CHAMBERLAYNE AVE,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23222-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8043292160,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F15.21","A41.9","N48.22","N49.2","B20.","N30.00","Z20.2","F17.210","Z79.899","Z04.1","Z65.1","R03.0","N34.2","R36.9","R19.5","Z20.822","F12.10","F14.10","F15.10","F17.200","N48.89","Z53.29","Z98.890","Z90.49","Z88.8","K62.89","R10.30","Z21.","A53.9","A74.9","A54.9","Z23.","R76.8","Z86.11"],"date":["2021-01-20","2021-12-24","2021-12-24","2021-12-24","2022-12-30","2022-07-02","2022-07-02","2021-09-13","2022-12-30","2022-04-02","2022-04-02","2022-04-02","2022-05-22","2022-05-22","2022-08-21","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2022-08-21","2022-08-21","2023-08-29","2021-12-20","2022-02-21","2022-02-21","2022-02-21","2021-12-20","2021-12-20"],"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":[["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","00228306011","AMPHET\/DEXTR","CAP 20MG ER","30","Select","Select",""],["","54092038701","ADDERALL XR","CAP 20MG","30","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","54092038701","ADDERALL XR CAP","20MG","30","Select","Select",""],["","00228306011","AMPHET\/DEXTR CAP","20MG ER","30","Select","Select",""],["","47781030301","NITROFURANTN CAP","100MG","14","Select","Select",""],["","53489011905","DOXYCYCL HYC CAP","100MG","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":""}]}]}