{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" MAILLIWSLLEW C ","gend":0,"add":"EB 9408TS TEKC","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1963-07-26","age":"","mstatus":"","insh":"6252110*71","cliId":"","pno":"7775756789","cno":"","email":"","ename":"","eno":"","pphy":"MILLER, JULIUS S MD","ppno":7575479286,"pcpadd":"113 GAINSBOROUGH SQ STE 300","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320-9998","pcpcounty":"","pcpid":"","pcpname":"Bayview Hospitalist","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":["Z12.11","E78.2","Z12.5","Z00.00","M22.2X2","I25.10","I49.8","S76.112A","R07.9","I21.4","F17.200","H90.3","H93.11","I20.0","E78.5","R07.89","I47.1","I49.3","Z72.0","F12.90","E78.00","G47.00","I25.110","F41.9","F17.210","Z71.6","Z79.899","Z80.9","G25.81","H91.91","M25.512","R94.39","I70.0","R00.2"],"date":["2021-08-30","2022-09-13","2022-09-13","2022-09-13","2022-12-01","2023-03-16","2023-04-03","2022-12-01","2023-02-16","2023-02-18","2023-02-17","2021-09-23","2021-09-23","2023-02-16","2023-02-16","2023-02-16","2023-04-27","2023-04-27","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2021-08-30","2021-08-30","2021-08-30","2023-02-16","2023-02-18","2023-04-03"],"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":[["","45963070911","METOPROLOL SUCCINATE","25 MG","15","Select","Select",""],["","00186077760","BRILINTA","90 MG","60","Select","Select",""],["","43598083305","ATORVASTATIN CALCIUM","80 MG","30","Select","Select",""],["","60505265301","TRAZODONE HCL","50 MG","90","Select","Select",""],["","68462025401","ROPINIROLE TAB","0.5MG","90","Select","Select",""],["","55111012105","ATORVASTATIN TAB","10MG","90","Select","Select",""],["","00536100836","ASPIRIN","81 MG","30","Select","Select",""],["","68382005105","MELOXICAM TAB","15MG","30","Select","Select",""],["","43598043611","NITROGLYCERIN","0.4 MG","25","Select","Select",""],["","13107000305","MIRTAZAPINE","30 MG","90","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":""}]}]}