{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ANITSIRHCSDRAWDE C ","gend":1,"add":"NAIDNI 054NL REMMUS ","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1982-06-15","age":"","mstatus":"","insh":"85000910*069","cliId":"","pno":"0375793874","cno":"","email":"","ename":"","eno":"","pphy":"NEWMAN, ROBERT J MD","ppno":7574465955,"pcpadd":"SUITE 118 825 FAIRFAX AVE,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","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":["R22.32","F41.9","F32.A","L73.2","M25.549","Z79.899","D64.9","H10.10","M79.642","R22.30","Z12.31","M25.542","S93.525A","M19.072","I83.11","I83.12","S93.525D","M79.605","M79.672","Z01.419","Z11.3","R60.9","M20.42","Z00.00"],"date":["2022-11-09","2022-08-03","2022-08-03","2023-01-26","2022-11-03","2022-11-17","2022-07-27","2022-07-27","2022-12-06","2022-12-06","2022-11-03","2022-07-27","2022-09-19","2022-10-26","2022-12-28","2022-12-28","2022-10-26","2022-12-28","2022-11-30","2023-01-11","2023-01-11","2022-12-05","2022-12-28","2023-01-26"],"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":[["","69097083512","SERTRALINE","TAB 100MG","30","Select","Select",""],["","00574050801","FERROUS GLUC","TAB 324MG","90","Select","Select",""],["","11845005741","B-12","TAB 100MCG","90","Select","Select",""],["","49483060450","IBUPROFEN","800 MG","90","Select","Select",""],["","45802086802","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","58602000739","OLOPATADINE","SOL 0.002","2","Select","Select",""],["","51672140004","CLINDAMYCIN","LOT 0.01","60","Select","Select",""],["","00074012402","HUMIRA PEN","INJ 80\/0.8ML","2","Select","Select",""],["","80681007100","VITAMIN B-12","TAB 100MCG","90","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","28","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","60","Select","Select",""],["","45802086802","POLYETH GLYC POW","3350 NF","238","Select","Select",""],["","11845005741","B-","12 TAB 100MCG","90","Select","Select",""],["","63304069301","CLINDAMYCIN CAP","300MG","20","Select","Select",""],["","58602000739","OLOPATADINE SOL","0.2%","2","Select","Select",""],["","00574050801","FERROUS GLUC TAB","324MG","90","Select","Select",""],["","69097083512","SERTRALINE TAB","100MG","30","Select","Select",""],["","49483060450","IBUPROFEN TAB","800MG","90","Select","Select",""],["","51672140004","CLINDAMYCIN LOT","1%","60","Select","Select",""],["","80681007100","VITAMIN B-","12 TAB 100MCG","90","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","53489011905","DOXYCYCL HYC CAP","100MG","28","Select","Select",""],["","00074012402","HUMIRA PEN INJ","80\/0.8ML","2","Select","Select",""],["","68180065208","DOXYCYC MONO CAP","100MG","60","Select","Select",""],["","68180065208","DOXYCYCLINE MONOHYDRATE","100 MG","60","Select","Select",""],["","53746051501","SPIRONOLACT TAB","100MG","30","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","53746051501","SPIRONOLACTONE","100 MG","90","Select","Select",""],["","51672140004","CLINDAMYCIN PHOSPHATE","1 %","60","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":""}]}]}