{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"K   NAVEUTMAIN ","gend":0,"add":" EEKOREHC 03201UTMAIN LIRPA DR","city":"RICHMOND","state":"VA","zip":"23235-9998","dob":"2002-07-25","age":"","mstatus":"","insh":"75000910*079","cliId":"","pno":"8340885757","cno":"","email":"","ename":"","eno":"","pphy":"KASKA, REBEKAH A NP","ppno":8048289350,"pcpadd":"417 N 11TH STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23298-9998","pcpcounty":"","pcpid":"","pcpname":"MCV ASSOCIATED PHYSICIANS","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"N","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":["R39.81","K92.1","R32.","G80.9","G40.909","R62.50","Q02.","R15.9","Z43.1","Z43.8","K21.9","F41.1","J45.909","Z93.1","Z01.30","Z68.1","G47.33","G47.00","Z99.89","Z79.899","K31.1","G40.89","G40.813","G80.8","J45.998","K44.9","F79.","R22.0","W19.XXXA","T14.8XXA"],"date":["2023-02-27","2023-02-27","2023-02-27","2023-02-27","2023-02-27","2023-02-27","2023-03-13","2023-02-27","2023-03-05","2023-03-05","2023-03-13","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2022-12-08","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-10-19","2023-01-04","2023-01-30","2023-03-13","2023-03-13","2023-03-13","2023-03-13","2023-02-02","2023-02-02","2023-02-02"],"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":[["","00574403105","TOBRAMYCIN-DE","XAM ETHASONE 0.3 %-0.1%","5","Select","Select",""],["","00536126659","SENNA","8.8MG\/5ML","237","Select","Select",""],["","70127010010","EPIDIOLEX","100 MG\/ML","210","Select","Select",""],["","30768016836","MELATONIN","1 MG\/ML","531","Select","Select",""],["","43386031214","GAVILAX","POW ","510","Select","Select",""],["","59779030603","CVS PURELAX","POW ","510","Select","Select",""],["","00093321205","CLONAZEPAM","1 MG","120","Select","Select",""],["","65862025047","LEVETIRACETA","SOL 100MG\/ML","900","Select","Select",""],["","00574403105","TOBRA\/DEXAME","SUS 0.3-0.1%","5","Select","Select",""],["","67877073295","LACOSAMIDE","10 MG\/ML","300","Select","Select",""],["","00574403105","TOBRAMYCIN-DEXAMETHASONE","0.3 %-0.1%","5","Select","Select",""],["","70954014810","PYRIDOSTIGMINE BROMIDE","60 MG\/5 ML","450","Select","Select",""],["","00536126659","SENNA LIQ","8.8\/5ML","237","Select","Select",""],["","70127010010","EPIDIOLEX SOL","100MG\/ML","210","Select","Select",""],["","30768016836","MELATONIN LIQ","1MG\/ML","177","Select","Select",""],["","43386031214","GAVILAX POW","","510","Select","Select",""],["","59779030603","CVS PURELAX POW","","510","Select","Select",""],["","00093321205","CLONAZEPAM TAB","1MG","120","Select","Select",""],["","65862025047","LEVETIRACETA SOL","100MG\/ML","900","Select","Select",""],["","00574403105","TOBRA\/DEXAME SUS","0.3-0.1%","5","Select","Select",""],["","65162006205","SUCRALFATE","1 G\/10 ML","900","Select","Select",""],["","76204090001","LEVALBUTEROL HCL","1.25MG\/3ML","180","Select","Select",""],["","59779030603","PURELAX","17 G\/DOSE","510","Select","Select",""],["","65862025047","LEVETIRACETAM","100 MG\/ML","2700","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":""}]}]}