{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" A  YMANOTRAB","gend":1,"add":" KCAB 803SERC YAB","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1970-04-05","age":"","mstatus":"","insh":"0243120*89","cliId":"","pno":"2775755101","cno":7574783139,"email":"","ename":"","eno":"","pphy":"MOSELEY, HEATHER MD","ppno":7576898430,"pcpadd":"1925 GLEN MITCHELL DR. STE 100","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23456-9998","pcpcounty":"","pcpid":"","pcpname":"Princess Anne 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":["M47.23","M47.22","M48.02","R10.13","R19.4","Z01.419","Z12.39","Z12.4","Z12.11","Z12.31","M50.30","M79.18","G89.29","M54.12","L82.1","Z71.9","Z00.00","M50.223","I47.2","Z20.828","M53.2X2","Z98.1","M47.812","L57.0","L81.4","D18.00","L57.8","D22.9","Z87.898","Z12.83","Z32.02","J40.","Z23.","Z01.411","J06.9","I47.20"],"date":["2022-01-26","2022-01-26","2022-09-15","2022-10-10","2022-05-26","2022-03-09","2022-03-09","2022-03-09","2022-03-09","2022-10-25","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-02-28","2022-02-28","2022-10-10","2022-02-09","2022-01-31","2021-08-24","2022-01-26","2022-01-26","2022-09-15","2021-02-24","2022-02-28","2022-02-28","2022-02-28","2022-02-28","2022-02-28","2022-02-28","2022-06-20","2023-01-31","2021-05-12","2022-03-09","2021-08-24","2022-10-10"],"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":[]},{"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":[["","00378427693","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","59746017506","PREDNISONE","20 MG","15","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0","Select","Select",""],["","00023530030","RHOFADE","CRE 0.01","30","Select","Select",""],["","51672411606","METRONIDAZOL","GEL 0.0075","45","Select","Select",""],["","41100081123","AFRIN","SPR 0.0005","15","Select","Select",""],["","68180067711","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","65862006299","METOPROL","TAB 25MG","45","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","42806071401","BENZONATATE","100 MG","15","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","65862006299","METOPROL TAR TAB","25MG","45","Select","Select",""],["","58160089052","FLUARIX QUAD INJ","2022-23","0","Select","Select",""],["","42571016242","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","70710112307","DOXYCYCLINE MONOHYDRATE","100 MG","14","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","00173068220","VENTOLIN HFA","90 MCG","18","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":""}]}]}