{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   IRROLECNARK L","gend":1,"add":"LNEH 61YAW SYE","city":"POQUOSON","state":"VA","zip":"23662-9998","dob":"1958-03-22","age":"","mstatus":"","insh":"0631210*79","cliId":"","pno":"68\/7572579-8","cno":"757\/236-5422","email":"","ename":"","eno":"","pphy":"HIOTELLIS, APOSTOLOS MD","ppno":"757\/659-6287","pcpadd":"860 OMNI BLVD SUITE 112","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"TPMG CITY CENTER FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Small Group","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":["R10.9","L82.0","L72.0","L82.1","D18.00","L81.4","D22.9","Z71.9","Z12.31","R20.2","R07.9","Z00.00","E78.00","R07.89","R10.11","J45.909","K21.9","Z79.82","Z79.899","K22.4","K21.00","Z12.11","Z23.","J40.","Z68.27","I24.9","R07.2","M62.82","R06.09","R13.14","K29.70","K31.7","K21.0","R25.2","R12.","R13.10","K44.9","R06.00","J98.01","R06.2","J98.9","Z68.26","E72.12","R47.02","R63.3","I78.1","I83.90","R09.02","Z90.710","M65.4","Z13.31","Z68.25","J01.00","I25.10","Z88.5","Z88.1","Z79.1"],"date":["2021-05-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-01","2021-01-28","2021-06-17","2021-06-28","2021-06-28","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-06-28","2021-06-28","2021-08-30","2021-04-23","2020-11-03","2020-11-03","2020-06-02","2020-06-02","2020-06-02","2020-06-02","2020-10-06","2020-10-06","2020-10-06","2020-10-06","2020-11-06","2020-11-06","2020-11-06","2020-11-06","2020-12-18","2020-08-27","2020-12-18","2020-09-23","2020-12-18","2020-06-02","2020-06-23","2020-06-23","2020-12-28","2020-12-28","2020-06-04","2020-06-02","2019-08-01","2019-08-01","2019-08-01","2020-07-01","2020-06-02","2020-06-02","2020-06-02","2020-06-02"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","61442010310","DICLOFENAC","TAB 75MG DR","180","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","70710112307","DOXYCYC","TAB 100MG","20","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","70710114801","ISOSORB","TAB 5MG","60","Select","Select",""],["","59779060027","CVS","TAB 81MG EC","30","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","55111015430","ONDANSETRON","TAB 8MG","21","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","90","Select","Select",""],["","11822989470","RA","TAB 81MG EC","30","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","30","Select","Select",""],["","43199001301","HYOSCYAMINE","TAB 0.125MG","270","Select","Select",""],["","88888888887","DMR","T ","1","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","33332032101","AFLURIA","INJ 2021-22","0","Select","Select",""],["","00254101196","SUCRALFATE","SUS 1GM\/10ML","414","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":""}]}]}