{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M   YRAMYENIAR ","gend":1,"add":"LEK 3362EVA REL","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1949-05-21","age":"","mstatus":"","insh":"03000910*071","cliId":"","pno":"27\/7574717-4","cno":"","email":"","ename":"","eno":"","pphy":"LAYNE, MICHAEL MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507","pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.39","H40.1121","E11.3591","H40.1113","E11.9","I10.","K57.32","M06.9","E78.00","Z86.010","Z98.42","Z98.41","Z87.891","Z90.710","Z80.1","Z79.899","Z79.82","Z79.84","E78.5","M54.5","K57.92","D64.9","H04.123","H43.811","H26.493","E11.3593","E11.65","M54.9","Z23.","D63.8","U07.1","Z00.00","Z12.31","M05.79","M25.512","G89.29","Z13.820","N17.9","M17.12","H81.10","R10.11","J06.9","R10.9","D72.829","M70.61","M65.341","M70.62","R07.89","Z13.31","E11.319","M79.0"],"date":["2021-06-29","2021-11-30","2020-01-07","2021-02-04","2021-05-14","2021-12-20","2020-10-25","2021-01-07","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2021-05-14","2020-10-25","2020-10-25","2021-09-13","2020-10-25","2020-10-25","2021-01-19","2021-09-13","2021-10-20","2020-10-30","2021-11-30","2021-11-30","2021-11-30","2021-06-29","2021-10-20","2021-05-13","2021-10-20","2021-10-20","2020-08-21","2021-01-07","2021-07-07","2021-09-13","2021-09-13","2021-09-13","2020-03-11","2020-10-13","2020-05-08","2020-08-20","2020-10-24","2020-03-16","2021-05-14","2020-10-24","2020-12-08","2020-12-08","2020-12-08","2021-06-08","2021-01-07","2021-01-07","2021-05-14"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","24208048610","DORZOL\/TIMOL","SOL 22.3-6.8","30","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","180","Select","Select",""],["","68645055754","LISINOP\/HCTZ","TAB 20-12.5","6","Select","Select",""],["","59762010405","SULFASALAZIN","TAB 500MG DR","360","Select","Select",""],["","16729048516","HYDROXYCHLOR","TAB 200MG","180","Select","Select",""],["","68382077501","METHOTREXATE","TAB 2.5MG","65","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","16729021317","DOXAZOSIN","TAB 4MG","90","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","69584061150","METHOCARBAM","TAB 500MG","10","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","-21","Select","Select",""],["","69097012815","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","10","Select","Select",""],["","16571041210","CIPROFLOXACN","TAB 500MG","-14","Select","Select",""],["","68382009305","CARVEDILOL","TAB 6.25MG","60","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","21","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}