{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ZSUIRAMKENAIMOP","gend":0,"add":"TSEW 608EVA REVO","city":"NORFOLK","state":"VA","zip":"23507-9998","dob":"1968-01-10","age":"","mstatus":"","insh":"0457110*58","cliId":"","pno":"2201509340","cno":5102204390,"email":"","ename":"","eno":"","pphy":"HUNTLEY-WAGNER, MARY NP","ppno":7573337625,"pcpadd":"813 INDEPENDENCE BLVD SUITE A","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23455-9998","pcpcounty":"","pcpid":"","pcpname":"INDEPENDENCE FAMILY MEDICINE","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":["E11.65","R00.2","M25.50","M25.521","M25.562","I10.","Z79.84","E78.2","R94.5","Z00.00","Z12.5","M05.79","M15.9","D84.9","I48.91","Z20.822","Z12.11","Z12.12","Z23.","M25.572"],"date":["2022-07-15","2021-05-06","2022-05-03","2022-03-17","2022-03-17","2022-08-22","2021-05-04","2022-08-22","2022-08-22","2022-08-22","2022-08-22","2023-05-08","2022-12-19","2022-12-19","2021-05-20","2022-02-15","2022-09-23","2022-09-23","2022-10-17","2023-04-03"],"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":[["","24208079535","NEO\/POLY\/DEX","OIN 0.1% OP","4","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00168005615","BETAMETH","OIN 0.0005","15","Select","Select",""],["","53746017805","METFORMIN","TAB 500MG ER","120","Select","Select",""],["","59651036205","IBUPROFEN","800 MG","30","Select","Select",""],["","68180098103","LISINOPRIL","20 MG","90","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00781261301","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00006008061","JANUMET","TAB 50-1000","60","Select","Select",""],["","00597015230","JARDIANCE","10 MG","90","Select","Select",""],["","16729002010","PIOGLITAZONE","TAB 15MG","30","Select","Select",""],["","50001046232","GOJJI","TES GLUCOSE","50","Select","Select",""],["","60219175203","SILDENAFIL","TAB 50MG","10","Select","Select",""],["","45802028139","TESTOSTERONE","GEL 0.0162","75","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","2","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","24208058060","GENTAMICIN","SOL 0.3% OP","5","Select","Select",""],["","71093013206","METFORMIN TAB","500MG","180","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","00169477212","OZEMPIC","2MG\/0.75ML","3","Select","Select",""],["","43547035411","LISINOPRIL TAB","20MG","90","Select","Select",""],["","64380080707","IBUPROFEN TAB","800MG","30","Select","Select",""],["","00002223680","TRULICITY INJ","3\/0.5","2","Select","Select",""],["","60505257908","ATORVASTATIN TAB","20MG","90","Select","Select",""],["","00597015230","JARDIANCE TAB","10MG","30","Select","Select",""],["","65162036110","FOLIC ACID TAB","1MG","30","Select","Select",""],["","00472037915","CLOTRIM\/BETA CRE DIPROP","","30","Select","Select",""],["","68382077501","METHOTREXATE TAB","2.5MG","24","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","3","Select","Select",""],["","59267102501","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","13107002005","HYDROCODONE-ACETAMINOPHEN","7.5-325 MG","8","Select","Select",""],["","66685100101","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","00169477212","OZEMPIC INJ","8MG\/3ML","1","Select","Select",""],["","68382077501","METHOTREXATE","2.5 MG","24","Select","Select",""],["","65162036110","FOLIC ACID","1 MG","30","Select","Select",""],["","70010049105","METFORMIN HCL ER","500 MG","360","Select","Select",""],["","60505257908","ATORVASTATIN CALCIUM","20 MG","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":""}]}]}