{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ECINAJEGAMAG P","gend":1,"add":"ROC 6332RD KCIN","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1952-12-18","age":"","mstatus":"","insh":"33000910*858","cliId":"","pno":"73\/7576688-7","cno":"","email":"","ename":"","eno":"","pphy":"OBERMEYER, PHAIK MD","ppno":"757\/321-6142","pcpadd":"840 FIRST COLONIAL ROAD SUITE 101","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23451,"pcpcounty":"","pcpid":"","pcpname":"Hague Medical Associates","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":["Z12.31","M25.562","M17.12","F32.0","G47.09","R63.5","K64.8","K63.5","H04.123","H16.223","H40.002","H35.372","Z86.010","F33.0","L57.0","L82.1","L24.9","D48.7","L91.8","R35.0","N39.0","F41.1","M17.11","M76.892","R30.0","C44.92","C44.722"],"date":["2022-09-08","2022-09-13","2022-09-13","2020-08-05","2022-06-23","2021-03-12","2021-10-26","2021-10-26","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2020-10-01","2021-03-12","2022-08-02","2022-08-02","2022-03-21","2022-10-12","2022-08-02","2022-07-05","2022-08-15","2022-06-23","2022-09-13","2022-09-13","2022-08-15","2022-10-12","2022-10-27"],"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":[["","68382005101","MELOXICAM","TAB 15MG","-30","Select","Select",""],["","65862016001","ZOLPIDEM","TAB 10MG","-30","Select","Select",""],["","10702002501","PHENTERMINE","TAB 37.5MG","80","Select","Select",""],["","57844000901","ADIPEX-P","TAB 37.5MG","30","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","-1","Select","Select",""],["","59417010310","VYVANSE","CAP 30MG","-30","Select","Select",""],["","61314063006","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","51672411806","FLUOROURACIL","CRE 0.05","40","Select","Select",""],["","45802043803","HYDROCORT","CRE 0.01","28","Select","Select",""],["","11822372390","RA","CRE 0.01","28","Select","Select",""],["","64380071306","BENZONATATE","CAP 200MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","51672130104","AMMONIUM","CRE 0.12","280","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","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":""}]}]}