{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GILBERT HAWKINS","gend":0,"add":"2308 OLD DOMINION ST APT 101","city":"RICHMOND","state":"VA","zip":"23224-9998","dob":"1982-10-05","age":"","mstatus":"","insh":"2476419*01","cliId":"","pno":7575971924,"cno":7575971924,"email":"","ename":"","eno":"","pphy":"BRUZZESE, VIVIAN MD","ppno":8046552794,"pcpadd":"108 COWARDIN AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23224-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8046220804,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K59.00","Z51.89","B20.","Z11.3","A04.8","L02.31","Z21.","F17.210","K62.5","K64.8","K29.70","F34.1","B08.09","M54.9","Z53.21","Z72.0","L02.91","K64.9","Z78.9","L02.32","F17.200"],"date":["2022-07-29","2023-02-27","2023-05-04","2022-07-07","2022-07-07","2023-05-02","2023-05-02","2023-02-27","2022-08-04","2022-08-04","2022-08-04","2023-05-17","2022-07-27","2023-04-12","2023-04-12","2023-05-04","2023-05-04","2023-05-04","2023-05-04","2023-05-02","2023-05-02"],"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":[["","49702022813","TIVICAY","50 MG","30","Select","Select",""],["","68462010230","FLUCONAZOLE","TAB 100MG","90","Select","Select",""],["","65162027250","SMZ\/TMP DS","TAB 800-160","90","Select","Select",""],["","59676057530","PREZCOBIX","800-150 MG","30","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","65162046650","IBUPROFEN","800 MG","15","Select","Select",""],["","42806031250","DOXYCYCLINE HYCLATE","100 MG","14","Select","Select",""],["","00406051201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","6","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","28","Select","Select",""],["","65162027210","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","30","Select","Select",""],["","24689012001","BUPROPION HCL","100 MG","60","Select","Select",""],["","00234057508","HIBICLENS","4 %","236","Select","Select",""],["","00093101042","MUPIROCIN","2 %","22","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":""}]}]}