{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NER  ASILYEKSIL EE","gend":1,"add":"GNILLAF 7124DAOR KEERC ","city":"BEDFORD","state":"VA","zip":"24523-9998","dob":"1964-07-29","age":"","mstatus":"","insh":"4225210*67","cliId":"","pno":"6643442450","cno":"","email":"","ename":"","eno":"","pphy":"JOHNSON, AMY NP","ppno":5405867273,"pcpadd":"171 WEST MAIN STREET","pcpcity":"BEDFORD","pcpstate":"VA","pcpzip":"24523-9998","pcpcounty":"","pcpid":"","pcpname":"CENTRA MEDICAL GROUP LLC","plan":"OHP","program":"ACA","lob":"Individual","region":"ROANOKE ALLEGHANY","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":["R07.9","J45.909","Z91.09","G47.33","K21.9","D71.","R55.","H16.141","K22.70","Z12.11","E10.65","Z96.41","I10.","E78.1","E78.00","I25.10","Z98.61","F07.81","F41.9","F32.9","E10.3291","E10.3392","H25.13","H04.223","E78.5","Z82.49","Z68.39","L81.9","L57.8","D22.72","D22.71","D22.5","Z79.4","E66.9","Z71.3","F32.A"],"date":["2023-05-19","2023-06-22","2023-05-23","2023-06-22","2023-05-23","2023-05-23","2023-05-23","2023-01-11","2023-03-09","2023-03-09","2023-06-22","2023-06-22","2023-06-22","2023-04-21","2023-02-27","2023-06-22","2023-06-22","2023-02-27","2023-06-22","2023-02-27","2023-06-13","2023-06-13","2023-06-13","2023-01-04","2023-05-19","2023-05-19","2023-06-22","2023-04-21","2023-07-17","2023-07-17","2023-07-17","2023-07-17","2023-02-07","2023-06-22","2023-06-22","2023-06-22"],"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":[["","00002751001","HUMALOG","100\/ML","150","Select","Select",""],["","08627007701","DEXCOM G","7 SENSOR","3","Select","Select",""],["","00173069600","ADVAIR DISKUS","250-50 MCG","60","Select","Select",""],["","61314063136","NEOMYCIN-POLYMYXIN-DEXAMETH","3.5-10K-.1","3.5","Select","Select",""],["","00378932132","WIXELA INHUB","250-50 MCG","60","Select","Select",""],["","08508300021","OMNIPOD","5 G6 PODS (GEN 5)","15","Select","Select",""],["","24208091055","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","43386031208","GAVILAX","17 G\/DOSE","238","Select","Select",""],["","49483000301","LAXATIVE","5 MG","2","Select","Select",""],["","00169280015","SAXENDA","3 MG\/0.5ML","15","Select","Select",""],["","63000033698","GUARDIAN SENSOR","3","5","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":""}]}]}