{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   EIRRAKYELDUTS M","gend":1,"add":" SILLERT 617301 TPA YAW","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1981-11-11","age":"","mstatus":"","insh":"5800210*02","cliId":"","pno":"32\/7574411-8","cno":"","email":"","ename":"","eno":"","pphy":"KEMENI, ROSINE NP","ppno":"757\/312-6797","pcpadd":"648 GRASSFIELD PKWY STE 1","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23322,"pcpcounty":"","pcpid":"","pcpname":"CHESAPEAKE REGIONAL MEDICAL GROUP","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":["M79.605","R20.0","Z68.42","G47.33","G40.909","R29.818","R56.9","G93.41","E78.5","F32.9","Z79.899","F41.1","F43.21","J04.0","R41.0","R41.3","F41.8","Z86.59","G31.84","F90.0","R42.","Z68.41","H53.022","H53.8","E55.9","E78.00","F41.9","N39.0","Z82.49","Z82.61","Z83.3","Z88.5","Z88.8","R41.841","R29.898","R55.","G62.9","Z86.69","F33.1","R27.8","R06.83","R06.81","Z51.81","Z20.828","I49.3","F51.01","I10.","G43.909","E66.01","R53.83","T14.8XXA","R10.13","R07.9","R74.8","R79.89","K83.8","R10.11","R11.0","R11.2","R80.9","J06.9","R23.3","R68.89","B34.9","R52.","R05.","Z91.048","K21.9","L98.9","Z71.3","R73.9","G40.409","Z88.6","M47.816","R20.2","R10.10","K31.9","K29.70","Z87.11","F33.9","R19.7","Z90.49","Z87.19","R31.29","M51.36","R79.1","R10.9","R10.12","D64.9","K29.80","Z12.11","Z91.018"],"date":["2021-02-17","2021-02-17","2021-12-06","2021-11-04","2021-04-28","2021-04-28","2021-11-05","2021-04-30","2021-04-30","2021-11-03","2021-06-15","2021-08-24","2021-05-02","2021-08-30","2021-04-29","2021-11-05","2021-06-25","2021-05-20","2021-09-28","2021-09-28","2021-09-28","2021-11-03","2021-11-09","2021-04-28","2021-04-28","2021-12-06","2021-11-03","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2021-12-14","2021-10-26","2021-12-11","2021-11-05","2021-04-28","2021-06-25","2021-06-25","2021-11-03","2021-11-03","2021-11-03","2021-08-30","2022-01-17","2020-11-05","2020-10-30","2020-10-02","2020-11-05","2020-10-27","2020-10-30","2019-01-24","2019-01-24","2019-01-24","2019-01-24","2019-01-28","2019-07-02","2020-10-13","2019-12-03","2019-07-30","2019-02-21","2020-02-18","2020-05-03","2020-05-03","2020-05-03","2020-05-03","2020-10-13","2020-11-05","2020-11-05","2020-11-05","2020-10-06","2020-10-06","2020-10-06","2020-12-16","2020-12-16","2019-01-20","2019-04-29","2019-04-30","2019-04-30","2019-07-30","2019-01-28","2019-01-28","2019-01-28","2019-01-30","2020-12-16","2019-01-20","2019-01-20","2019-12-03","2019-12-03","2019-10-05","2019-10-05","2019-09-17"],"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":[["","68001033200","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","00781531701","ZOLPIDEM","TAB 5MG","-30","Select","Select",""],["","27808015601","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00093720298","PRAVASTATIN","TAB 40MG","30","Select","Select",""],["","16729021716","SERTRALINE","TAB 100MG","30","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","60","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","30","Select","Select",""],["","29300011101","LAMOTRIGINE","TAB 25MG","180","Select","Select",""],["","68001024617","ONDANSETRON","TAB 4MG ODT","6","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","00228202910","ALPRAZOLAM","TAB 0.5MG","12","Select","Select",""],["","00591024001","LORAZEPAM","TAB 0.5MG","2","Select","Select",""],["","64380080706","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","00143993905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","88888888887","DMR","T ","1","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","20","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","20","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","18","Select","Select",""],["","00093526901","ZALEPLON","CAP 10MG","-30","Select","Select",""],["","00527128201","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","21","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","60","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":""}]}]}