{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YHTORODNEERG B ","gend":1,"add":" ROLYAT 5513304 TPA EVA","city":"WEST POINT","state":"VA","zip":"23181-9998","dob":"1946-07-11","age":"","mstatus":"","insh":"95000910*730","cliId":"","pno":"5840886314","cno":8048541368,"email":"","ename":"","eno":"","pphy":"ALEJO, ANDREA J MD","ppno":8046932720,"pcpadd":"SUITE 2200 7547 MEDICAL DRIVE","pcpcity":"GLOUCESTER","pcpstate":"VA","pcpzip":"23061-9998","pcpcounty":"","pcpid":"","pcpname":"Internal Medicine Associates of Gloucester","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","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":["I12.9","E11.22","N18.31","E78.49","J44.9","E03.9","F17.200","Z79.84","D64.9","R09.02","R05.9","R62.7","Z74.3","R53.1","Z09.","U07.1","J12.82","J44.1","I13.10","J96.01","N18.30","E87.6","A41.89","E78.5","K21.9","F17.210","Z79.82","Z79.02","Z23.","J44.0","E11.69","Z79.890","Z79.899","I25.10","E04.2","M54.50","E04.1"],"date":["2023-02-01","2023-02-01","2023-02-01","2023-02-01","2022-09-23","2023-02-01","2023-02-01","2022-09-23","2022-10-10","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-10-06","2022-10-06","2022-10-06","2023-02-01","2022-09-16","2022-09-16","2022-09-23","2022-09-16","2022-09-16","2022-09-23","2022-09-16","2022-09-23","2022-09-23","2022-09-23","2022-08-01","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2023-02-01","2023-02-24","2023-02-01","2023-03-16"],"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":[["","69238183007","LEVOTHYROXIN","TAB 25MCG","90","Select","Select",""],["","68462039610","OMEPRAZOLE","20 MG","90","Select","Select",""],["","11917009215","FERROUS SULF","TAB 325MG","90","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","200","Select","Select",""],["","55111019605","CLOPIDOGREL","75 MG","90","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","180","Select","Select",""],["","00054418325","DEXAMETHASON","TAB 2MG","2","Select","Select",""],["","62332005090","LOSARTAN\/HCT","TAB 100-25","90","Select","Select",""],["","00378395005","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","29300039810","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","70954005920","PREDNISONE","10 MG","42","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","200","Select","Select",""],["","00173086910","ANORO ELLIPTA","62.5-25MCG","60","Select","Select",""],["","31722053301","METHOCARBAMOL","500 MG","60","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","90","Select","Select",""],["","68180021709","LOSARTAN-HYDROCHLOROTHIAZIDE","100MG-25MG","90","Select","Select",""],["","67877056105","METFORMIN TAB","500MG","180","Select","Select",""],["","00378395005","ATORVASTATIN TAB","10MG","90","Select","Select",""],["","68462039610","OMEPRAZOLE CAP","20MG","90","Select","Select",""],["","69238183007","LEVOTHYROXIN TAB","25MCG","90","Select","Select",""],["","29300039810","AMLODIPINE TAB","10MG","90","Select","Select",""],["","55111019605","CLOPIDOGREL TAB","75MG","90","Select","Select",""],["","62332005090","LOSARTAN\/HCT TAB","100-25","90","Select","Select",""],["","11917009215","FERROUS SULF TAB","325MG","90","Select","Select",""],["","00054418325","DEXAMETHASON TAB","2MG","2","Select","Select",""],["","70954005920","PREDNISONE TAB","10MG","42","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","200","Select","Select",""],["","67877056105","METFORMIN HCL","500 MG","180","Select","Select",""],["","00378395005","ATORVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","10 MG","90","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":""}]}]}