{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D   KRAMSREVAEB ","gend":0,"add":"KSIRAMAT 72G TPA YAUQ ","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1957-07-08","age":"","mstatus":"","insh":"85000910*894","cliId":"","pno":"1275729398","cno":7572189392,"email":"","ename":"","eno":"","pphy":"VAUGHAN, CHARLES M MD","ppno":7578730360,"pcpadd":"SUITE 110 11803 JEFFERSON AVENUE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"RIVERSIDE PHYSICIAN SERVICES INC","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":["M25.562","M25.561","M17.0","N40.3","J32.4","R09.81","I48.0","R00.2","R94.31","I10.","Z79.01","I49.9","I48.19","I50.30","Z79.899","Z98.890","E83.42","Z86.718","I51.7"],"date":["2022-11-02","2022-11-02","2022-11-02","2022-09-06","2022-09-26","2022-08-30","2023-01-25","2023-01-24","2023-01-10","2023-01-10","2023-02-03","2023-01-25","2023-02-03","2023-02-03","2023-02-03","2023-01-25","2023-01-25","2023-01-25","2023-01-18"],"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":[["","70461012203","FLUAD QUADRI","INJ 2022-23","0","Select","Select",""],["","00115180401","HYDROXYZ PAM","CAP 50MG","60","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","30","Select","Select",""],["","50228014610","HYDROCHLOROT","CAP 12.5MG","90","Select","Select",""],["","60505008000","SOTALOL HCL","TAB 80MG","180","Select","Select",""],["","31722064430","TADALAFIL","TAB 5MG","30","Select","Select",""],["","65862020290","LOSARTAN POT","TAB 50MG","90","Select","Select",""],["","50458057930","XARELTO","20 MG","90","Select","Select",""],["","47781035703","BUPRENORPHINE-NALOXONE","8 MG-2 MG","30","Select","Select",""],["","63304071990","DILTIAZEM","24HR ER (CD) 180 MG","30","Select","Select",""],["","00115180401","HYDROXYZINE PAMOATE","50 MG","60","Select","Select",""],["","60219175303","SILDENAFIL CITRATE","100 MG","6","Select","Select",""],["","69097080232","TESTOSTERONE CYPIONATE","200 MG\/ML","10","Select","Select",""],["","08287126101","EXEL SYRINGE","23GX1\"","20","Select","Select",""],["","08290305195","REGULAR BEVEL NEEDLES","18GX1\"","20","Select","Select",""],["","60505008000","SOTALOL","80 MG","180","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":""}]}]}