{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R  YRREPLLERRAH ","gend":0,"add":"ALED 5001EVA ERAW","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1997-07-29","age":"","mstatus":"","insh":"0473430*16","cliId":"","pno":"7375798436","cno":"","email":"","ename":"","eno":"","pphy":"NEIN, CHRISTOPHER D MD","ppno":7579832200,"pcpadd":"3920 A BRIDGE RD STE 207","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23435-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Belle Harbour","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":["R40.4","R09.02","F80.1","Z72.89","R90.82","F84.0","F41.9","Z51.81","F32.9","R11.2","L60.0","L98.9","Z79.899","S61.401A","R11.0","F72.","G40.209","Z11.1","F79.","F63.9","F41.1","F33.9","F71.","F07.89","Z00.00","S61.451A","S61.452A","W50.3XXA","Z23.","S51.851A","Z20.822","H47.293","F48.2","F80.2","F51.05","F34.9","F34.89","R45.87","S60.511A","S60.411A"],"date":["2021-02-10","2021-02-10","2022-08-15","2022-08-15","2022-08-15","2023-01-12","2023-02-24","2021-03-15","2022-08-15","2022-08-15","2023-01-12","2021-02-10","2021-02-10","2021-02-10","2021-06-11","2021-03-04","2021-03-05","2022-07-01","2022-12-30","2022-12-30","2023-05-12","2022-12-30","2023-07-07","2023-02-24","2021-03-09","2021-02-11","2021-02-11","2021-07-10","2021-02-11","2021-07-10","2021-02-10","2023-06-14","2023-07-07","2023-07-07","2023-07-07","2023-07-07","2023-05-12","2023-05-12","2023-07-03","2023-07-03"],"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":[["","67877021901","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","00093342501","LORAZEPAM","0.5 MG","60","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","43547034106","RISPERIDONE","TAB 1MG","90","Select","Select",""],["","68462029817","CLOTRIM\/BETA","CRE DIPROP","30","Select","Select",""],["","00185067601","HYDROXYZ","CAP 50MG","120","Select","Select",""],["","65862001230","SERTRALINE","TAB 50MG","60","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","1","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","68180035209","SERTRALINE TAB","50MG","90","Select","Select",""],["","67877021901","CEPHALEXIN CAP","500MG","30","Select","Select",""],["","51672413001","LAMOTRIGINE","25 MG","42","Select","Select",""],["","00115180301","HYDROXYZINE PAMOATE","25 MG","120","Select","Select",""],["","00555032304","HYDROXYZ PAM CAP","25MG","120","Select","Select",""],["","00093342501","LORAZEPAM TAB","0.5MG","60","Select","Select",""],["","51672413001","LAMOTRIGINE TAB","25MG","42","Select","Select",""],["","68382098206","LAMOTRIGINE ER","200 MG","30","Select","Select",""],["","68180035206","SERTRALINE HCL","50 MG","90","Select","Select",""],["","63304061650","DOXYCYCLINE MONOHYDRATE","100 MG","20","Select","Select",""],["","00143924920","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","31722082030","ARIPIPRAZOLE","5 MG","30","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":""}]}]}