{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROF C   NIBORRELEEHW-NAME","gend":1,"add":"PAC 8006LP LATI","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1975-11-28","age":"","mstatus":"","insh":"2017610*40","cliId":"","pno":"6524193","cno":7573350062,"email":"","ename":"","eno":"","pphy":"BELARDO, BETYSHIA J MD","ppno":7574137600,"pcpadd":"STE 301 5320 PROVIDENCE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23464-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","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":["Z23.","K75.4","Z68.42","R29.898","M79.651","G47.33","Z01.419","Z12.39","Z30.011","M41.84","M41.9","M19.032","I83.891","Z12.31","M54.42","M25.552","G89.29","G95.89","Z12.11","K63.5","Z80.0","Z00.00","R35.0","E66.01","K74.3","R73.03","E78.6","E78.00","L30.1","R73.9","Z83.3","Z99.89","Z20.822","Z12.4","D12.5","G47.30","Z79.3","Z79.899","Z88.2","K21.9","R06.83","R40.0","G47.00","Z72.821","G43.009","H65.03","M77.8","I80.01","Z68.41","M54.50","M75.22"],"date":["2021-04-06","2023-01-11","2023-01-11","2022-01-11","2022-01-11","2023-02-03","2022-09-12","2022-09-12","2021-09-01","2023-01-18","2023-01-18","2023-03-16","2023-03-17","2022-09-09","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2021-04-12","2021-04-12","2021-04-08","2023-01-11","2022-01-10","2023-01-11","2023-01-11","2023-01-11","2022-01-10","2023-01-11","2021-01-07","2021-01-07","2021-01-07","2022-07-28","2021-04-05","2021-09-01","2021-04-12","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2022-07-28","2022-07-28","2022-07-28","2022-07-28","2023-01-11","2022-11-22","2023-03-16","2023-03-17","2022-06-08","2023-01-11","2023-01-23"],"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":[["","31722019205","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","00054016625","MYCOPHENOLAT","TAB 500MG","120","Select","Select",""],["","51862056401","LOW-OGESTREL","TAB ","84","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","51672125906","CLOBETASOL","OIN 0.0005","45","Select","Select",""],["","00555904958","CRYSELLE-28","TAB 28 TABS","84","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00555902658","JUNEL","TAB 43831","84","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","65862094088","AUROVELA","TAB 43831","84","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":""}]}]}