{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"F  CIREBUARTS ","gend":0,"add":"TETIHW 5071DAOR ENROH","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1979-12-31","age":"","mstatus":"","insh":"5399110*52","cliId":"","pno":"8675763197","cno":"","email":"","ename":"","eno":"","pphy":"AUSTIN, WARREN E MD","ppno":7576898430,"pcpadd":"1925 GLENN MITCHELL DRIVE STE 100","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23456-9998","pcpcounty":"","pcpid":"","pcpname":"Princess Anne Medical Associates","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":["Z01.84","Z23.","M45.9","M10.9","D84.9","S90.212A","N28.1","K82.8","K76.0","R59.9","I10.","K60.3","Z11.1","L02.91","K82.4","M27.2","Z00.00","R73.09","R68.84","F45.8","H43.813","J03.90","Z11.52","Z76.89","Z20.822","M86.9","K61.1","N28.89","L72.3","K62.89","Z87.891","N50.89","R07.81"],"date":["2022-01-28","2022-01-28","2022-12-12","2022-12-12","2022-12-12","2022-06-29","2023-03-10","2022-12-29","2023-03-10","2022-12-29","2022-12-29","2023-04-05","2023-01-26","2023-02-16","2023-03-10","2021-03-08","2021-05-28","2021-05-28","2021-06-24","2021-06-24","2021-07-13","2022-12-27","2022-12-27","2021-05-28","2021-12-27","2021-03-03","2022-12-06","2022-12-06","2023-04-03","2023-04-03","2023-04-03","2023-04-17","2023-05-21"],"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":[["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00074055402","HUMIRA","INJ 40\/0.4ML","2","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","68180098103","LISINOPRIL","20 MG","90","Select","Select",""],["","70377000712","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","55111073005","ALLOPURINOL","300 MG","90","Select","Select",""],["","00254200801","COLCHICINE","TAB 0.6MG","90","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","49281072010","FLUBLOK","INJ 2020-21","0","Select","Select",""],["","47781019601","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","28","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","500 MG","21","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","00074055402","HUMIRA PEN INJ","40\/0.4ML","2","Select","Select",""],["","55111073005","ALLOPURINOL TAB","300MG","90","Select","Select",""],["","63304069301","CLINDAMYCIN CAP","300MG","21","Select","Select",""],["","70377000712","ROSUVASTATIN TAB","10MG","90","Select","Select",""],["","68180098103","LISINOPRIL TAB","20MG","90","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","00254200801","COLCHICINE TAB","0.6MG","90","Select","Select",""],["","49483060450","IBUPROFEN TAB","800MG","30","Select","Select",""],["","42571016242","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","6","Select","Select",""],["","70377000712","ROSUVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","10702001801","OXYCODONE HCL","5 MG","8","Select","Select",""],["","00074055402","HUMIRA(CF) PEN","40MG\/0.4ML","2","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":""}]}]}