{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOSE RIVAS","gend":0,"add":"183 ATKINSON DR APT C","city":"WARSAW","state":"VA","zip":"22572-9998","dob":"1989-11-01","age":"","mstatus":"","insh":"9425268*01","cliId":"","pno":8043335164,"cno":8043335164,"email":"","ename":"","eno":"","pphy":"HALLAM, JESSICA C NP","ppno":8046284327,"pcpadd":"417 N 11TH STREET,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23298-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048283673,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","Z23.","Q24.9","Q21.3","I51.7","Q26.1","Q21.0","I50.9","I45.89","F41.9","Z95.0","Z86.16","Z87.891","Z79.899","R00.2","I11.0","I48.91","Z87.74","Z95.2","Z95.810","Z91.14","G47.9","R06.02","I49.5","E66.9","I48.92","U07.1","Z68.30","Z20.828","R07.9","S61.211A","W26.0XXA","Y99.0","J10.1","Z20.822","I10.","NO DATA","Z79.01","I50.32","I49.8","R06.00","Z45.02","I42.0","Z98.890","R50.9","J09.X2","I49.9","G47.00","Z95.818","I36.1","E66.09","S61.216A","R19.7","R51.9","R09.82","J34.89","J02.9","R05.9","R11.0","M25.9","Y92.89"],"date":["2021-02-03","2021-03-25","2023-06-16","2023-06-16","2021-05-12","2023-06-16","2021-05-12","2023-08-04","2023-06-16","2022-05-23","2021-05-12","2021-05-12","2022-12-01","2023-08-04","2023-08-04","2023-08-04","2023-08-04","2022-02-22","2023-08-04","2023-08-04","2021-11-14","2022-04-09","2022-04-09","2022-04-09","2021-01-15","2021-06-07","2021-01-15","2023-06-16","2021-02-22","2023-08-07","2022-02-22","2022-05-29","2022-02-22","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2023-08-04","2021-01-06","2023-06-16","2021-03-24","2021-04-28","2021-03-24","2023-06-16","2022-12-01","2022-11-27","2022-05-23","2021-03-17","2021-03-18","2021-03-18","2023-06-16","2022-05-29","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2022-05-29"],"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":[["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","00245014430","PACERONE","100 MG","60","Select","Select",""],["","57664037713","TRAMADOL HCL","TAB 50MG","10","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","180","Select","Select",""],["","00406996201","TEMAZEPAM","CAP 30MG","6","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","20","Select","Select",""],["","65862006299","METOPROLOL TARTRATE","25 MG","180","Select","Select",""],["","51672405506","AMIODARONE HCL","100 MG","60","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":""}]}]}