{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" SELRAHCBBEW J ","gend":0,"add":"BRATS 121RIC DRAO","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"1967-09-26","age":"","mstatus":"","insh":"5032210*22","cliId":"","pno":"4775725156","cno":7578741970,"email":"","ename":"","eno":"","pphy":"LAVENDER, KEVIN A MD","ppno":7578770214,"pcpadd":"13347 WARWICK BOULEVARD","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23602-9998","pcpcounty":"","pcpid":"","pcpname":"TIDEWATER PHYSICIANS MULTISPECIALTY GROUP PC","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":["N13.2","Z12.11","J45.909","Z79.51","Z79.899","R10.9","J06.9","B96.89","Z20.822"],"date":["2022-12-18","2021-08-30","2022-12-18","2022-12-18","2022-12-18","2022-12-18","2023-05-09","2023-05-09","2023-05-09"],"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":[["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","69097082307","CITALOPRAM TAB","20MG","30","Select","Select",""],["","16729013616","CLONAZEPAM TAB","0.5MG","30","Select","Select",""],["","57237011490","ALFUZOSIN TAB","10MG ER","5","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","15","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","Select","Select",""],["","68382070718","DOXYCYC MONO CAP","100MG","14","Select","Select",""],["","13668001105","CITALOPRAM HBR","40 MG","60","Select","Select",""],["","00781261305","AMOXICILLIN","500 MG","21","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","10","Select","Select",""],["","66993058597","FLUTICASONE-SALMETEROL","250-50 MCG","60","Select","Select",""],["","00173069600","ADVAIR DISKUS","250-50 MCG","60","Select","Select",""],["","00121077516","GUAIFENESIN-CODEINE","10-100MG\/5","120","Select","Select",""],["","27808023302","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","59746017509","PREDNISONE","20 MG","10","Select","Select",""],["","00173071620","ADVAIR HFA","115-21MCG","12","Select","Select",""],["","66993008796","FLUTICASONE-SALMETEROL HFA","115-21MCG","24","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":""}]}]}