{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   LRAEPNELLA L","gend":1,"add":"SRAM 1374EVA LLAH","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1951-07-18","age":"","mstatus":"","insh":"35000910*908","cliId":"","pno":"32\/7570707-6","cno":"","email":"","ename":"","eno":"","pphy":"LORENZO, DAVID L MD","ppno":"757\/380-8709","pcpadd":"4714 MARSHALL AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"pcpcounty":"","pcpid":"","pcpname":"PENINSULA INSTITUTE FOR COMMUNITY HEALTH","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":["E11.9","I10.","E78.00","E03.9","G62.9","Z12.11","Z12.31","J32.9","R60.9","M25.562","K92.1","H25.13","H52.03","H52.4","Z68.30","Z23."],"date":["2022-09-08","2022-09-08","2022-09-08","2022-09-08","2022-04-07","2022-07-13","2022-08-18","2022-07-05","2022-07-05","2022-09-08","2022-07-05","2022-03-30","2022-03-30","2022-03-30","2022-09-08","2022-10-26"],"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":[["","65162010211","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16729022501","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","57664050658","METOPROL","TAB 25MG","180","Select","Select",""],["","16714004107","ALLOPURINOL","TAB 100MG","180","Select","Select",""],["","11877001140","BINAXNOW","KIT HOME TES","2","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","60505009300","DOXAZOSIN","TAB 1MG","30","Select","Select",""],["","68645057559","GLIPIZIDE","TAB 10MG","90","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","16729044715","LEVOTHYROXIN","TAB 25MCG","90","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","42571012290","LEVOCETIRIZI","TAB 5MG","90","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00093720210","PRAVASTATIN","TAB 40MG","90","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","90","Select","Select",""],["","59267102504","PFIZER","INJ ADLT RTU","0","Select","Select",""],["","16714008110","HYDROXYZ","TAB 10MG","90","Select","Select",""],["","43528000305","HEPLISAV-B","INJ 20\/0.5ML","0","Select","Select",""],["","72305002530","EUTHYROX","TAB 25MCG","90","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","49281012265","FLUZONE","INJ 2022-23","1","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":{"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":""}]}]}