{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LLADNEKSSORG ","gend":1,"add":"INRUB 5572NL EERT GN","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1958-09-10","age":"","mstatus":"","insh":"2420120*33","cliId":"","pno":"35\/7570352-8","cno":"757\/547-0220","email":"","ename":"","eno":"","pphy":"SAVAGE-ARTIS, SHEREE L NP","ppno":"757\/738-1375","pcpadd":"148 BURNETTS WAY SUITE 107","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS SUFFOLK PRIMARY CARE","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":["Z23.","Z12.31","Z00.00","R73.03","I10.","Z13.29","Z13.228","Z13.0","Z13.6","R63.4","E78.2","R73.01","Z12.11","R73.9","L24.89","B35.3","E11.9","H43.811","H25.043","H35.033","H16.223","I25.10","Z76.0","Z68.27","Z85.3","I50.9","Z68.25","Z01.810","E78.5","I42.9","J06.9","J01.00","R05.","R07.9","R10.2","R31.9","L08.9","L20.89","R21.","R93.1","R35.0","N39.0","N76.0","R94.39"],"date":["2021-08-03","2021-03-15","2021-10-05","2022-01-31","2022-02-10","2022-01-31","2022-01-31","2022-01-31","2022-01-31","2021-10-06","2021-10-06","2021-06-04","2022-01-05","2021-10-06","2022-03-03","2022-03-03","2022-02-10","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2022-02-10","2022-02-10","2022-02-10","2021-03-15","2021-12-05","2021-12-05","2021-11-10","2021-11-10","2021-11-10","2019-08-22","2019-08-22","2019-08-22","2019-09-24","2020-07-02","2020-07-02","2019-11-20","2019-10-18","2019-11-20","2019-09-24","2020-06-02","2020-06-02","2020-06-02","2019-09-24"],"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":[["","68645056259","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","72205000490","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","68462079917","NYSTAT\/TRIAM","OIN ","15","Select","Select",""],["","00904404073","ASPIRIN","CHW 81MG","-30","Select","Select",""],["","31722070090","LOSARTAN","TAB 25MG","-90","Select","Select",""],["","68382009305","CARVEDILOL","TAB 6.25MG","60","Select","Select",""],["","00093505798","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00603107558","CHERATUSSIN","SYP AC","120","Select","Select",""],["","69238115403","EZETIMIBE","TAB 10MG","90","Select","Select",""],["","13668010401","ISOSORB","TAB 30MG ER","30","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","18","Select","Select",""],["","51672129803","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","68462018022","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","64011060128","INTRAROSA","SUP 6.5MG","28","Select","Select",""],["","49348049807","SM","CHW 81MG","30","Select","Select",""],["","49035027468","EQ","CHW 81MG","30","Select","Select",""],["","27437005101","SOLOSEC","GRA 2GM","1","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","55111014601","FLUCONAZOLE","TAB 200MG","2","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","100","Select","Select",""],["","70710112307","DOXYCYC","TAB 100MG","10","Select","Select",""],["","23155001801","TETRACYCLINE","CAP 500MG","20","Select","Select",""],["","00472040060","CLOBETASOL","CRE 0.0005","-60","Select","Select",""],["","68645057454","GLIPIZIDE","TAB 5MG","30","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","67877041301","METFORMIN","TAB 500MG ER","180","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","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":""}]}]}