{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C  HAROBEDSWEHTTAM ","gend":1,"add":"REHS 713RD DOOW","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1967-06-01","age":"","mstatus":"","insh":"1910210*95","cliId":"","pno":"3375775634","cno":7575391533,"email":"","ename":"","eno":"","pphy":"SMITH, DONNA C NP","ppno":7573573331,"pcpadd":"201 GUMWOOD DR","pcpcity":"SMITHFIELD","pcpstate":"VA","pcpzip":"23430-9998","pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICAL CARE OF SMITHFIELD PLC","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":["L25.9","Z71.9","R76.8","R21.","Z79.899","L30.8","M25.571","M76.71","M19.071","Z12.4","L43.9","Z01.419","R87.619","A60.9","R20.1","R30.0","Z12.31","L20.9","Z68.33","L21.9","L30.4","I47.1","R00.2","I49.1","I49.3","Z80.0","Z86.010","R76.0","D48.5","L81.4","Z86.39","Z68.34","Z12.39","M32.10","H25.13","H04.123","D31.30","Z68.35","M33.90","R82.998","R93.2","N76.2","L30.9"],"date":["2021-06-22","2021-05-11","2021-06-07","2023-06-22","2023-06-22","2022-12-07","2022-12-01","2022-12-06","2022-12-06","2023-07-18","2023-03-31","2023-07-18","2021-11-15","2021-11-29","2022-03-16","2022-12-07","2023-07-18","2021-01-05","2021-01-05","2022-01-19","2023-04-21","2022-09-23","2022-08-30","2022-09-23","2022-09-23","2022-12-21","2022-12-21","2023-01-10","2021-01-12","2021-01-12","2021-07-13","2021-07-13","2021-11-22","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-08-24","2023-06-07","2023-04-18","2023-04-18","2023-03-31","2023-04-21"],"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":[["","00093354143","ESTRADIOL","0.01 %","42.5","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","60","Select","Select",""],["","64764017530","DEXILANT","CAP 60MG DR","90","Select","Select",""],["","68462022555","MOMETASONE","OIN 0.001","45","Select","Select",""],["","00093101042","MUPIROCIN","2 %","22","Select","Select",""],["","00168027740","CLINDAMYCIN","CRE 2% VAG","120","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","65862015901","ZOLPIDEM","TAB 5MG","2","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","68462053435","TACROLIMUS","0.1 %","60","Select","Select",""],["","69336083030","LIDOTREX","GEL 0.02","57","Select","Select",""],["","65862044930","VALACYCLOVIR","TAB 1GM","90","Select","Select",""],["","17478071130","LIDOCAINE","GEL 2% JELLY","60","Select","Select",""],["","66977010005","REGENECARE","GEL ","56","Select","Select",""],["","59746017306","PREDNISONE","10 MG","30","Select","Select",""],["","69238154401","HYDROXYCHLOR","TAB 200MG","180","Select","Select",""],["","00168008031","HYDROCORT","CRE 0.025","30","Select","Select",""],["","45802006405","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","42794008008","ACITRETIN","10 MG","30","Select","Select",""],["","00054455015","METHOTREXATE","TAB 2.5MG","32","Select","Select",""],["","11534016501","FOLIC","TAB 1MG","90","Select","Select",""],["","69238153206","CLOBETASOL","CRE 0.0005","60","Select","Select",""],["","68462074617","ACYCLOVIR","OIN 0.05","15","Select","Select",""],["","00093901965","CYCLOSPORINE MODIFIED","50 MG","150","Select","Select",""],["","63646001004","KETOCONAZOLE SHA","2%","120","Select","Select",""],["","65862044930","VALACYCLOVIR TAB","1GM","90","Select","Select",""],["","45802005911","NYSTATIN","100000\/G","180","Select","Select",""],["","51672129303","CLOBETASOL SOL","0.05%","50","Select","Select",""],["","69238154401","HYDROXYCHLOR TAB","200MG","180","Select","Select",""],["","24979070406","DEXLANSOPRAZ CAP","60MG DR","90","Select","Select",""],["","64764017530","DEXILANT CAP","60MG DR","90","Select","Select",""],["","00054455015","METHOTREXATE TAB","2.5MG","32","Select","Select",""],["","11534016501","FOLIC ACID TAB","1MG","90","Select","Select",""],["","00093354143","ESTRADIOL CRE","0.01%","42","Select","Select",""],["","59746017306","PREDNISONE TAB","10MG","12","Select","Select",""],["","00093506101","HYDROXYZ HCL TAB","25MG","30","Select","Select",""],["","0","COMPOUND","","454","Select","Select",""],["","00093101042","MUPIROCIN OIN","2%","22","Select","Select",""],["","51672127302","FLUOCINONIDE SOL","0.05%","60","Select","Select",""],["","68462053465","TACROLIMUS OIN","0.1%","60","Select","Select",""],["","64380072506","MYCOPHENOLAT TAB","500MG","90","Select","Select",""],["","00115175008","ACITRETIN CAP","10MG","30","Select","Select",""],["","50881000705","OPZELURA CRE","1.5%","240","Select","Select",""],["","00093901965","CYCLOSPORINE CAP","50MG MOD","90","Select","Select",""],["","60505003306","PENTOXIFYLLINE","400 MG","90","Select","Select",""],["","16571020110","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","64380072506","MYCOPHENOLATE MOFETIL","500 MG","90","Select","Select",""],["","68382005101","MELOXICAM TAB","15MG","30","Select","Select",""],["","68382005105","MELOXICAM","15 MG","30","Select","Select",""],["","67877025145","TRIAMCINOLONE ACETONIDE","0.1 %","454","Select","Select",""],["","16714043901","NITROFURANTN CAP","100MG","10","Select","Select",""],["","69238154401","HYDROXYCHLOROQUINE SULFATE","200 MG","60","Select","Select",""],["","00168014630","HYDROCORTISONE","2.5 %","28.35","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":""}]}]}