{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"K   YMAREKRAP ","gend":1,"add":"ILRETS 6203RD TNIOP GN","city":"PORTSMOUTH","state":"VA","zip":"23703-9998","dob":"1970-03-31","age":"","mstatus":"","insh":"0608120*71","cliId":"","pno":"9375725750","cno":7573905752,"email":"","ename":"","eno":"","pphy":"HAYES, CHRISTIANNE C NP","ppno":7579831777,"pcpadd":"213 RIVER WALK PKWY STE 101","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320-9998","pcpcounty":"","pcpid":"","pcpname":"SENTARA MEDICAL GROUP","plan":"OHP","program":"ACA","lob":"Individual","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":["Z00.00","E78.00","F33.42","Z12.11","E55.9","Z13.89","Z13.29","Z13.228","Z13.0","Z12.31","F31.4","Z01.419","Z83.71","K57.90","K64.8","D22.9","I78.1","L82.1","L81.4","M75.01","M25.511","R22.31","Z11.3"],"date":["2021-11-08","2021-11-08","2021-11-08","2022-02-02","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2023-03-22","2021-02-08","2022-11-14","2022-02-02","2022-02-02","2022-02-02","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2021-01-13","2021-01-13","2021-02-15","2021-06-02"],"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":[["","10370017511","FLUVOXAMINE","CAP 100MG ER","60","Select","Select",""],["","68382000801","LAMOTRIGINE","TAB 100MG","270","Select","Select",""],["","13668013701","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","65862042001","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","33332032001","AFLURIA","INJ 2020-21","0","Select","Select",""],["","45802014167","CICLOPIROX","SOL 0.08","7","Select","Select",""],["","42806066301","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","49884030602","CLONAZEP","TAB 0.125MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","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":""}]}]}