{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IHT   AGNHNID YM ","gend":1,"add":"NAH 512RD SNIK","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1960-10-13","age":"","mstatus":"","insh":"0820210*83","cliId":"","pno":"77\/7577217-8","cno":"","email":"","ename":"","eno":"","pphy":"LE, DAU T MD","ppno":"757\/671-8746","pcpadd":"SUITE 104 5444 VIRGINIA BEACH BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"DAU T LE MD","plan":"OHP","program":"ACA","lob":"Individual","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":["E03.9","E11.65","Z20.828","R51.9","E11.3312","H25.813","H04.123","E11.3313","E11.21","N18.1","Z12.31","S92.425D","E11.40","E78.5","E11.3311","I12.9","E11.9","R80.9","R31.29","H26.9","Z00.01","Z12.11","H35.373","H25.13","Z01.818","H25.811","N02.9","R80.0","I10.","H10.45","H43.812","H57.11","H43.811","H04.121","H01.009","H25.12","E78.2","E03.8","H25.812","S92.425A"],"date":["2021-05-01","2021-08-18","2021-06-01","2021-06-01","2021-12-06","2021-07-06","2021-12-06","2021-10-25","2021-08-07","2021-08-17","2021-10-08","2020-04-02","2021-08-18","2020-12-16","2021-12-06","2021-07-06","2021-08-17","2021-07-06","2021-07-06","2021-08-02","2020-10-02","2021-05-23","2021-12-06","2021-08-06","2021-08-06","2021-06-28","2021-08-17","2021-08-17","2021-08-18","2020-08-25","2021-03-29","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-10-05","2020-12-28","2020-12-28","2021-08-02","2020-10-03"],"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":[["","69097081507","GABAPENTIN","CAP 400MG","30","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","70377000315","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","00378180910","LEVOTHYROXIN","TAB 100MCG","90","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","13668015830","TELMISARTAN","TAB 80MG","30","Select","Select",""],["","67877056310","METFORMIN","TAB 1000MG","-180","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","00378081005","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","15","Select","Select",""],["","68180021609","LOSARTAN\/HCT","TAB 100-12.5","90","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","200","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","15","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","400","Select","Select",""],["","43598029390","PREGABALIN","CAP 75MG","180","Select","Select",""],["","45802025742","MOMETASONE","CRE 0.001","45","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","60758088005","FLUOROMETHOL","SUS 0.1% OP","15","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","65862097803","TELMISA\/HCTZ","TAB 80-25MG","-90","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","61314014305","BRIMONIDINE","SOL 0.2% OP","5","Select","Select",""],["","60505100301","KETOROLAC","SOL 0.005","5","Select","Select",""],["","61314064305","TOBRAMYCIN","SOL 0.3% OP","5","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","31722070090","LOSARTAN","TAB 25MG","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}