{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NEBANASTOYJLETAP K   ","gend":1,"add":"EPSA 7171RD DOOWN","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1958-06-01","age":"","mstatus":"","insh":"4750210*83","cliId":"","pno":"2875718255","cno":"","email":"","ename":"","eno":"","pphy":"PATEL, CHHAYABEN V MD","ppno":7572438550,"pcpadd":"11848 ROCK LANDING DRIVE STE 401","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"Lakeview Internal Medicine Meade","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":["I10.","E11.9","K21.9","G47.00","M81.0","E78.5","R79.89","Z12.11","F51.01","Z12.31","Z13.820","L02.01"],"date":["2022-06-20","2022-06-20","2022-04-20","2021-08-04","2022-04-20","2022-06-20","2022-06-20","2021-08-30","2022-04-20","2022-04-20","2022-04-20","2022-04-18"],"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":[["","53746010901","HYDROCO\/APAP","TAB 5-325MG","21","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","61314063710","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","67877056110","METFORMIN","TAB 500MG","180","Select","Select",""],["","65862032904","ALENDRONATE","TAB 70MG","12","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0","Select","Select",""],["","65702048110","ACCU-CHEK","KIT FASTCLIX","200","Select","Select",""],["","10702002501","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","63304082905","ATORVASTATIN","TAB 40MG","180","Select","Select",""],["","65862023703","IBANDRONATE","TAB 150MG","1","Select","Select",""],["","86790001930","SLOW","TAB 45MG","30","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","13668000705","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","58337000301","VIVOTIF","CAP EC","4","Select","Select",""],["","49035061246","ALLERGY","TAB 10MG","30","Select","Select",""],["","53885000810","ONETOUCH","MIS PLUS 33G","400","Select","Select",""],["","00761022120","VITAMIN","TAB 1000 CR","90","Select","Select",""],["","31722070190","LOSARTAN","TAB 50MG","180","Select","Select",""],["","66993006027","ATOVAQ\/PROGU","TAB 250-100","30","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00002879759","HUMALOG","INJ 75\/25KWP","45","Select","Select",""],["","21292001080","PEN  NEEDLES","MIS 32GX4MM","400","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":""}]}]}