{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARE   YARLEICAM OD","gend":0,"add":"TTOT 6164NL EGDIRE","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1961-03-29","age":"","mstatus":"","insh":"0731210*75","cliId":"","pno":"26\/7571774-1","cno":"757\/621-7780","email":"","ename":"","eno":"","pphy":"TOBIN, WHITNEY E PA","ppno":"757\/464-6944","pcpadd":"4445 CORPORATION LN STE 120","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"Pembroke Medical Associates","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":["Z20.828","Z20.822","Z48.23","I10.","Z79.899","Z71.89","Z94.4","Z94.0","R97.20","N40.1","R35.1","R50.9","R05.9","Z23.","Z12.11","Z00.00","M25.511","G89.29","L21.9","Z12.83","D22.9"],"date":["2020-07-29","2021-12-06","2020-09-01","2021-07-07","2020-09-01","2021-07-07","2021-11-08","2020-12-10","2021-02-24","2021-01-22","2021-01-22","2021-12-07","2021-12-14","2021-04-15","2021-12-08","2021-12-01","2021-07-07","2021-07-07","2019-01-24","2019-01-24","2019-01-24"],"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":[["","00781210201","TACROLIMUS","CAP 0.5MG","90","Select","Select",""],["","16729009401","MYCOPHENOLAT","CAP 250MG","60","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","00713067115","KETOCONAZOLE","CRE 0.02","45","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","1","Select","Select",""],["","00132020140","FLEET","ENE ","133","Select","Select",""],["","49281072110","FLUBLOK","INJ 2021-22","0","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","5","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","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":""}]}]}