{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" LIAGIBAEPOP N ","gend":1,"add":"LAYOR 303HCONROD ","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"2005-03-02","age":"","mstatus":"","insh":"5218150*74","cliId":"","pno":"6875750699","cno":7573575670,"email":"","ename":"","eno":"","pphy":"POPE, THOMAS C MD","ppno":7573573331,"pcpadd":"201 GUMWOOD DR","pcpcity":"SMITHFIELD","pcpstate":"VA","pcpzip":"23430-9998","pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICAL CARE OF SMITHFIELD PLC","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":["Z01.810","I49.8","Z03.89","Q26.8","Q24.5","I36.1","I37.1","Z95.5","Z23.","N83.291","F42.4","Q26.3","Q22.0","Q26.4","Z86.16","Q26.1","Z03.818","R05.1","I28.8","F41.1","F40.11","F32.1","I37.0","Q25.6","Z00.129","J02.9","I44.0","Z11.1","U07.1","I97.89","Z79.899","Z86.79","Z79.82","R10.31","N83.201","Z98.890","I48.91","I48.20","Z48.812","Z45.2","Z09.","Z95.828","Z30.41","Q22.1","F32.4","R91.8"],"date":["2021-06-18","2021-03-17","2021-07-16","2021-06-22","2021-06-21","2021-06-22","2021-06-22","2021-10-28","2022-11-04","2023-01-30","2023-04-06","2021-03-19","2021-03-18","2021-06-22","2021-03-18","2021-03-18","2023-01-31","2021-10-07","2023-07-10","2023-06-12","2023-06-12","2023-05-15","2021-03-25","2022-06-16","2022-08-09","2023-03-16","2021-06-18","2021-07-14","2021-03-03","2021-03-18","2021-10-28","2023-04-20","2023-04-20","2022-11-03","2022-11-03","2023-04-20","2021-06-18","2021-06-18","2021-06-22","2021-03-18","2023-04-20","2023-04-20","2023-03-29","2023-05-10","2023-06-12","2023-07-10"],"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":[["","31722063231","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","24338018304","SKLICE","LOT 0.005","117","Select","Select",""],["","51672529404","MALATHION","LOT 0.005","59","Select","Select",""],["","69202078088","ULESFIA","LOT 0.05","227","Select","Select",""],["","00299382345","SOOLANTRA","CRE 0.01","45","Select","Select",""],["","28595057004","SPINOSAD","SUS 0.009","120","Select","Select",""],["","16714040604","LARIN","TAB 43831","84","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","57896091136","ASPIRIN","CHW 81MG","30","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","62332002231","FLUOXETINE HCL","10 MG","30","Select","Select",""],["","68180087773","JENCYCLA","0.35 MG","84","Select","Select",""],["","00378728353","NORETHINDRONE-E.ESTRADIOL-IRON","1MG-20(21)","84","Select","Select",""],["","00378727253","NORETHINDRON TAB","0.35MG","84","Select","Select",""],["","00093310953","AMOXICILLIN CAP","500MG","4","Select","Select",""],["","68180087773","JENCYCLA TAB","0.35MG","84","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":""}]}]}