{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" D   NIBORNOSREDNAS","gend":1,"add":"NODELBMIW 713C TPA ESAHC ","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1968-12-23","age":"","mstatus":"","insh":"0421220*44","cliId":"","pno":"3475740815","cno":7574351804,"email":"","ename":"","eno":"","pphy":"HANSEN, ROBERT B MD","ppno":7574613141,"pcpadd":"6275 E VIRGINIA BEACH BLVD SUITE 30","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23502-9998","pcpcounty":"","pcpid":"","pcpname":"ROBERT B HANSEN MD","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":["G89.4","F07.81","G43.719","Q20.2","Z79.891","G56.00","M54.2","R53.83","M25.519","G43.711","M50.30","B00.52","M54.5","M60.9","M54.50","R21.","M31.6","M53.83"],"date":["2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2022-10-27","2022-10-27","2021-10-07","2021-05-07","2021-09-07","2022-10-27","2022-10-27","2022-10-27","2021-05-10","2021-05-10"],"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":[["","00378343393","ARMODAFINIL","TAB 250MG","30","Select","Select",""],["","00008112312","DUAVEE","TAB 0.45-20","90","Select","Select",""],["","42858000401","OXYCODONE","TAB 20MG","90","Select","Select",""],["","50228010901","CARISOPRODOL","TAB 350MG","120","Select","Select",""],["","47781042747","FENTANYL","DIS 75MCG\/HR","15","Select","Select",""],["","64764075030","TRINTELLIX","TAB 20MG","30","Select","Select",""],["","00069046903","CHANTIX","PAK 1MG","56","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","55111068405","IBU","TAB 800MG","30","Select","Select",""],["","10702001101","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","65862062690","RIZATRIPTAN","TAB 10MG ODT","12","Select","Select",""],["","42043022109","SUMATRIPTAN","TAB 50MG","60","Select","Select",""],["","68462015813","ONDANSETRON","TAB 8MG ODT","90","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00023650110","UBRELVY","TAB 100MG","30","Select","Select",""],["","55513084101","AIMOVIG","INJ 70MG\/ML","1","Select","Select",""],["","13107010401","OXYMORPHONE","TAB HCL 10MG","90","Select","Select",""],["","54092060601","XIIDRA","DRO 0.05","60","Select","Select",""],["","61314012605","KETOROLAC","SOL 0.005","5","Select","Select",""],["","75834012929","NORETH\/ETHIN","TAB 0.5-2.5","28","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","15","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","90","Select","Select",""],["","63304090430","VALACYCLOVIR","TAB 500MG","30","Select","Select",""],["","57237000930","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","70710111208","TIZANIDINE","CAP 4MG","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":[]}},{"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":""}]}]}