{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   DRAHCIRNOSNURB K","gend":0,"add":"EVE 5271RIC TSER","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1961-08-01","age":"","mstatus":"","insh":"0612110*45","cliId":"","pno":"1775792047","cno":7577370402,"email":"","ename":"","eno":"","pphy":"BORZA, MERIDITH DO","ppno":8049685700,"pcpadd":"5000 COX ROAD SUITE 100","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":"23060-9998","pcpcounty":"","pcpid":"","pcpname":"PATIENT FIRST RICHMOND MEDICAL GROUP PLLC","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":["R35.0","L57.4","L21.8","L24.9","Z85.828","L90.5","E11.9","H66.002","H60.92","G47.30","I10.","R80.9","E66.3","Z23.","E66.9","E29.1","Z12.11","M54.50","R07.9","Z79.84","E78.41","G47.33","L30.9","S90.111A","S33.5XXA"],"date":["2021-08-06","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2023-03-16","2022-03-05","2022-03-05","2022-03-05","2023-02-27","2023-02-27","2023-02-27","2021-12-09","2023-03-16","2022-03-28","2021-08-30","2023-03-16","2023-03-16","2023-03-16","2023-03-16","2023-03-16","2021-02-26","2022-04-14","2022-04-14"],"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":[["","66993066330","DULOXETINE","CAP 30MG","30","Select","Select",""],["","68645055254","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","180","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","TES LITE","50","Select","Select",""],["","69238134201","ETODOLAC","TAB 400MG","20","Select","Select",""],["","59746017710","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","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":""}]}]}