{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   HARAFATTUHB B","gend":1,"add":"YENOH 604NL ELKCUS","city":"YORKTOWN","state":"VA","zip":"23693-9998","dob":"1960-03-02","age":"","mstatus":"","insh":"2150210*64","cliId":"","pno":"6775710026","cno":7577662770,"email":"","ename":"","eno":"","pphy":"NAGRAJ, HOSKOTE S MD","ppno":7572344285,"pcpadd":"12652 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23602-9998","pcpcounty":"","pcpid":"","pcpname":"Riverside Internal Medicine of Denbigh","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":["F32.9","L40.50","L40.59","L40.9","N89.9","Z79.899","L40.0","M79.18","R53.83","Z20.822","R73.02","E78.5","F41.9","Z22.7","R76.11","Z79.2","H66.001","Z00.00","D56.3","L65.9","L81.9","M51.16","M51.17","M54.59","L53.8","L81.1","L70.9","Z71.9","Z03.818","R51.9","Z63.6","Z83.49","F32.A","Z86.11","R76.12","Z12.31","M47.27","M79.672","J01.00","J01.20","Z12.11","J06.9","B96.89","Z20.828","E53.8","Z23."],"date":["2022-12-30","2021-06-11","2021-07-01","2021-06-11","2021-06-11","2022-09-26","2021-09-10","2021-07-01","2021-07-01","2023-01-06","2022-03-14","2022-03-01","2022-03-01","2022-09-26","2022-07-15","2022-09-26","2021-01-09","2022-10-26","2022-03-14","2021-09-01","2021-09-01","2023-02-24","2023-02-24","2023-02-28","2021-12-13","2021-12-13","2021-12-13","2021-12-13","2022-03-05","2022-06-03","2021-08-31","2022-03-14","2022-03-14","2022-07-15","2022-08-22","2022-10-27","2023-02-24","2021-05-15","2022-06-15","2022-06-15","2021-08-30","2023-01-06","2023-01-06","2021-01-14","2021-04-26","2022-10-26"],"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":[["","68382066201","SPIRONOLACT","TAB 100MG","90","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00074055402","HUMIRA","INJ 40\/0.4ML","2","Select","Select",""],["","00378623301","CITALOPRAM","TAB 40MG","90","Select","Select",""],["","16714049401","AMOX\/K","TAB 500-125","20","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00054472825","PREDNISONE","TAB 5MG","25","Select","Select",""],["","68180031906","BUPROPN","TAB 150MG XL","90","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","10","Select","Select",""],["","65862019401","FLUOXETINE","CAP 40MG","60","Select","Select",""],["","60258018601","POLY-IRON","CAP 150 FORT","30","Select","Select",""],["","55111028130","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","55111011230","MOXIFLOXACIN","TAB 400MG","10","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","69452014320","BENZONATATE","CAP 100MG","21","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","50111078766","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","90","Select","Select",""],["","00173071720","ADVAIR","AER 230\/21","12","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","47335023583","METHOTREXATE","TAB 2.5MG","60","Select","Select",""],["","49281063315","FLUZONE","INJ 2020-21","0","Select","Select",""],["","68180096701","LEVOTHYROXIN","TAB 75MCG","90","Select","Select",""],["","00143992701","CIPROFLOXACN","TAB 250MG","14","Select","Select",""],["","67877025115","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","51991020301","FERREX","CAP 150MG","90","Select","Select",""],["","16729004517","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","69918030130","TRANEX","TAB 650MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","68462053465","TACROLIMUS","OIN 0.001","60","Select","Select",""],["","70461012103","FLUAD","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":""}]}]}