{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L  YNNHOJNOTFILC ","gend":0,"add":"LARENEG 1491DVLB HTOOB ","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1962-02-07","age":"","mstatus":"","insh":"7050210*22","cliId":"","pno":"1275799857","cno":"","email":"","ename":"","eno":"","pphy":"BALDERSTON, MATTHEW G MD","ppno":7574995550,"pcpadd":"351 EDWIN DR STE 102","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23462-9998","pcpcounty":"","pcpid":"","pcpname":"HOLLAND ROAD FAMILY MEDICINE","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":["D72.819","C91.40","U07.1","J12.82","C91.91","Z51.11","Z20.828","L82.1","J96.01","D53.9","E78.5","D53.1","Z13.79","N28.1","K76.89","R16.1","Z00.00","Z12.5","R91.8","J18.1","R79.1","J90.","R06.02","J98.4","D72.829","D70.2","D48.5","D22.9","L81.4","I78.1","Z71.9","J18.9","R09.89","L57.0","L72.9","J15.9","E44.0","K59.00","Z83.49","Z68.22"],"date":["2022-11-22","2023-04-03","2021-04-12","2021-04-12","2023-03-27","2021-04-23","2021-08-25","2022-12-13","2021-01-11","2021-01-11","2022-11-22","2021-01-10","2021-04-05","2021-04-06","2021-04-06","2021-04-06","2022-11-22","2022-11-22","2021-01-02","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-01-07","2021-03-15","2022-12-05","2022-12-13","2022-12-13","2022-12-13","2022-12-13","2022-12-13","2021-01-02","2021-01-02","2022-10-04","2022-10-04","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2021-01-06"],"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":[["","69238199301","BUT\/ASA\/CAF\/","CAP CODEINE","36","Select","Select",""],["","31722071101","SILDENAFIL","TAB 100MG","30","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","33332032001","AFLURIA","INJ 2020-21","0","Select","Select",""],["","72205000490","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","6","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","6","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","6","Select","Select",""],["","00955100410","ENOXAPARIN","INJ 40\/0.4ML","4","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","45","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","00591264101","BUT\/APAP\/CAF","CAP CODEINE","60","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","30","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","9","Select","Select",""],["","68382079101","ACYCLOVIR","TAB 400MG","56","Select","Select",""],["","57237000630","FLUCONAZOLE","TAB 200MG","28","Select","Select",""],["","00126007492","PREVDNT","PST 0.011","100","Select","Select",""],["","51862094205","DIAZEPAM","TAB 5MG","1","Select","Select",""],["","65862015901","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","00054300001","BUT\/APAP\/CAF CAP CODEINE","","18","Select","Select",""],["","68382050010","OMEPRAZOLE","40 MG","90","Select","Select",""],["","68382050010","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","65862015901","ZOLPIDEM TAB","5MG","30","Select","Select",""],["","11877001140","BINAXNOW COV KIT HOME TES","","8","Select","Select",""],["","31722071101","SILDENAFIL TAB","100MG","30","Select","Select",""],["","72205000490","ROSUVASTATIN TAB","20MG","90","Select","Select",""],["","00069108530","PAXLOVID TAB","300-100","30","Select","Select",""],["","65862015901","ZOLPIDEM TARTRATE","5 MG","30","Select","Select",""],["","00054300001","BUTALB-ACETAMINOPH-CAFF-CODEIN","50-325-30","60","Select","Select",""],["","31722071101","SILDENAFIL CITRATE","100 MG","30","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":""}]}]}