{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B   AILUJNOSREDNA ","gend":1,"add":"SRETRAC 266DAOR ELLIV","city":"CUMBERLAND","state":"VA","zip":"23040-9998","dob":"1949-10-07","age":"","mstatus":"","insh":"05000910*689","cliId":"","pno":"33\/4088894-2","cno":"","email":"","ename":"","eno":"","pphy":"BRENGEL, GEORGE MD","ppno":"804\/560-8838","pcpadd":"SUITE 1-A 9220 FOREST HILL AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23235,"pcpcounty":"","pcpid":"","pcpname":"COMMONWEALTH INTERNAL MEDICINE ASSOCIATES","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","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","E11.65","E11.9","Z79.4","H25.12","M47.26","M54.16","H25.11","Z12.11","M50.30","M54.12","M51.36","R91.1","Z87.09","E66.01","H25.13","E11.40","M47.816","Z12.31","J06.9","R51.9","R05.9","R09.81","R53.83","J45.909","I10.","K21.9","M19.90","G47.33","Z68.41","Z90.49","Z71.3","Z79.899","Z88.7"],"date":["2022-03-14","2022-03-14","2022-11-05","2022-07-07","2022-06-13","2022-07-21","2022-10-13","2022-06-20","2022-07-13","2022-07-11","2022-07-11","2022-10-13","2022-01-12","2022-01-12","2022-11-05","2022-04-26","2022-07-07","2022-10-13","2022-10-24","2022-11-05","2022-11-05","2022-11-05","2022-11-05","2022-11-05","2022-11-05","2022-11-05","2022-11-05","2022-11-05","2022-11-05","2022-11-05","2022-11-05","2022-11-05","2022-11-05","2022-11-05"],"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":[["","00002831501","HUMULIN","INJ U-100","30","Select","Select",""],["","98302000104","LANCETS","MIS THIN","100","Select","Select",""],["","69097012815","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","70461012103","FLUAD","INJ 2021-22","0","Select","Select",""],["","57664037718","TRAMADOL","TAB 50MG","15","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","7","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","65162010211","GABAPENTIN","CAP 300MG","120","Select","Select",""],["","00169183402","NOVOLIN","INJ RELION","10","Select","Select",""],["","00781729685","ALBUTEROL","AER HFA","40","Select","Select",""],["","70010006510","METFORMIN","TAB 1000MG","180","Select","Select",""],["","43547028010","ESCITALOPRAM","TAB 5MG","90","Select","Select",""],["","65862085999","FAMOTIDINE","TAB 20MG","180","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","17478071310","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","61314012605","KETOROLAC","SOL 0.005","5","Select","Select",""],["","57896091136","ASPIRIN","CHW 81MG","30","Select","Select",""],["","00172392660","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","80777027310","MODERNA","INJ COVID-19","0","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","270","Select","Select",""],["","72205001390","PREGABALIN","CAP 75MG","90","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","49281012265","FLUZONE","INJ 2022-23","1","Select","Select",""],["","70710112307","DOXYCYC","TAB 100MG","14","Select","Select",""],["","66993007996","FLUTICAS","AER 110MCG","12","Select","Select",""],["","00173071820","FLOVENT","AER 44MCG","11","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}