{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"W   SEMAJRUMKEERC ","gend":0,"add":"YTIC 118TS LLAH ","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1958-07-16","age":"","mstatus":"","insh":"75000910*044","cliId":"","pno":"4975785243","cno":"","email":"","ename":"","eno":"","pphy":"BRAWLEY, JESSICA MD","ppno":7573126267,"pcpadd":"908 EDEN WAY N STE 101","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320-9998","pcpcounty":"","pcpid":"","pcpname":"CHESAPEAKE REGIONAL MEDICAL GROUP","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","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":["C61.","I10.","E78.5","F10.20","Z86.73","F32.9","R97.20","F17.200","Z68.29","E55.9","K21.9","Z12.11","G47.00","J44.9","N20.0","N40.1","N52.9","N13.8","N42.32","M15.8","M15.9","M25.551","Z68.30"],"date":["2022-12-28","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-09-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-11-07","2022-12-06","2022-12-06","2022-12-06","2022-12-06","2022-11-07","2022-12-28","2022-12-28","2022-12-28","2022-12-27"],"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":[]},{"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":[["","31722070210","LOSARTAN POT","TAB 100MG","30","Select","Select",""],["","57237001899","DULOXETINE","CAP 30MG","30","Select","Select",""],["","67877024910","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","64380073706","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","65862059805","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","67877051110","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","57237016199","OMEPRAZOLE","20 MG","30","Select","Select",""],["","49502080693","YUPELRI","SOL ","540","Select","Select",""],["","59267102501","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","49483048110","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","33342002332","LEVOFLOXACIN","TAB 750MG","1","Select","Select",""],["","11534016503","FOLIC ACID","TAB 1MG","30","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","58160082311","SHINGRIX","50 MCG\/0.5","1","Select","Select",""],["","67877024910","QUETIAPINE TAB","50MG","30","Select","Select",""],["","57237001899","DULOXETINE CAP","30MG","30","Select","Select",""],["","31722070210","LOSARTAN POT TAB","100MG","30","Select","Select",""],["","67877019905","AMLODIPINE TAB","10MG","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","57237016199","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","67877051110","ATORVASTATIN TAB","10MG","30","Select","Select",""],["","65862059805","TAMSULOSIN CAP","0.4MG","30","Select","Select",""],["","49502080693","YUPELRI SOL","","540","Select","Select",""],["","64380073706","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","59267102501","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","33342002332","LEVOFLOXACIN TAB","750MG","1","Select","Select",""],["","49483048110","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","70461032203","FLUCLVX QUAD INJ","2022-23","0","Select","Select",""],["","11534016503","FOLIC ACID TAB","1MG","30","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","67877024910","QUETIAPINE FUMARATE","50 MG","30","Select","Select",""],["","65862059805","TAMSULOSIN HCL","0.4 MG","30","Select","Select",""],["","57237001899","DULOXETINE HCL","30 MG","30","Select","Select",""],["","67877051110","ATORVASTATIN CALCIUM","10 MG","30","Select","Select",""],["","31722070210","LOSARTAN POTASSIUM","100 MG","30","Select","Select",""],["","67877019905","AMLODIPINE BESYLATE","10 MG","30","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":""}]}]}