{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YROGERGYELDIR E","gend":0,"add":"AH 6004TC YELI","city":"CHESAPEAKE","state":"VA","zip":"23321-9998","dob":"1976-01-20","age":"","mstatus":"","insh":"0384910*36","cliId":"","pno":"7375784265","cno":7574652743,"email":"","ename":"","eno":"","pphy":"THOMAS, BRANT MD","ppno":7574813770,"pcpadd":"STE 4 1821 OLD DONATION PKY","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":"","pcpname":"LIFEWAY FAMILY PHYSICIANS PC","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":["L65.9","R07.2","R07.9","I10.","R05.3","F17.200","M76.30","R05.9","R61.","E78.2","R73.03","Z12.5","Z11.59","J02.9","I49.1","I49.3","R06.02","I12.9","N18.31","F17.210","U07.1"],"date":["2021-12-28","2023-01-19","2023-01-14","2023-01-19","2023-04-28","2023-01-13","2021-12-10","2023-01-13","2023-01-13","2023-06-16","2023-06-16","2023-02-22","2023-02-22","2023-03-11","2023-01-14","2023-01-14","2023-01-14","2023-06-16","2023-06-16","2023-05-23","2023-05-23"],"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":[["","00172572960","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","59746021106","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","65162024709","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","15","Select","Select",""],["","00172392770","DIAZEPAM","TAB 10MG","1","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","60505476505","APO-VARENICL","TAB 0.5MG","53","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","31722070090","LOSARTAN","TAB 25MG","90","Select","Select",""],["","43386002606","FLUOCINONIDE","SOL 0.0005","60","Select","Select",""],["","65162024709","CHLORTHALID TAB","25MG","90","Select","Select",""],["","43547035310","LISINOPRIL","10 MG","90","Select","Select",""],["","59746017506","PREDNISONE","20 MG","6","Select","Select",""],["","70436015541","PROMETHAZINE-DM","6.25-15\/5","110","Select","Select",""],["","31722070190","LOSARTAN POT TAB","50MG","30","Select","Select",""],["","43547035310","LISINOPRIL TAB","10MG","90","Select","Select",""],["","69238138003","DIFLUPREDNAT EMU","0.05%","5","Select","Select",""],["","31722088390","ROSUVASTATIN CALCIUM","10 MG","30","Select","Select",""],["","49884094499","VARENICLINE","0.5 (11)-1","53","Select","Select",""],["","00310737220","BUDESONIDE-FORMOTEROL FUMARATE","80-4.5 MCG","10.2","Select","Select",""],["","55111064505","OMEPRAZOLE","40 MG","30","Select","Select",""],["","00054074287","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","65162024709","CHLORTHALIDONE","25 MG","90","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","31722070190","LOSARTAN POTASSIUM","50 MG","30","Select","Select",""],["","57237002901","AMOXICILLIN","875 MG","20","Select","Select",""],["","27808008601","HYDROCODONE-CHLORPHENIRAMNE ER","10-8MG\/5ML","60","Select","Select",""],["","42806071501","BENZONATATE","200 MG","30","Select","Select",""],["","43598081115","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00069034530","PAXLOVID (EUA)","300-100 MG","30","Select","Select",""],["","24208045705","DICLOFENAC SODIUM","0.1 %","5","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":""}]}]}