{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"R NAMORNAMHKYA","gend":0,"add":"BRAH 407YAUQ RO","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1965-07-16","age":"","mstatus":"","insh":"7702520*98","cliId":"","pno":"3475706666","cno":7574082751,"email":"","ename":"","eno":"","pphy":"BACKENS, MATTHEW V MD","ppno":7574995550,"pcpadd":"351 EDWIN DRIVE SUITE 102","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23462-9998","pcpcounty":"","pcpid":"","pcpname":"HOLLAND ROAD FAMILY MEDICINE","plan":"OHP","program":"ACA","lob":"Individual","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":["C18.7","C77.8","C78.00","C78.7","Z51.11","C20.","C78.01","C78.02","C79.71","Z79.899","G47.00","D64.81","T45.1X5A","C19.","G62.9","D50.9","K44.9","N28.1","N40.0","K76.89","E27.8","C18.9","C79.89","R59.0","K22.89","E27.9","Z98.890","Z95.828","C18.8","D70.1","G62.0","L27.0","Z79.634","Z79.620","Z85.048","Q44.6","K52.1","Z08.","Z85.038","R11.0","G47.09","L30.8"],"date":["2023-07-17","2023-07-17","2023-07-17","2023-07-17","2023-02-20","2023-06-19","2023-07-23","2023-07-23","2023-06-19","2023-06-19","2023-04-17","2023-07-03","2023-07-03","2023-01-23","2023-01-23","2023-01-23","2023-07-23","2023-04-16","2023-07-23","2023-07-03","2023-07-23","2023-07-23","2023-04-16","2023-04-16","2023-04-16","2023-04-16","2023-04-16","2023-04-16","2023-05-01","2023-06-05","2023-07-03","2023-05-15","2023-06-05","2023-06-05","2023-07-03","2023-06-05","2023-06-05","2023-07-03","2023-07-03","2023-07-03","2023-07-03","2023-07-03"],"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":[["","16714044801","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","60505257808","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","72205000792","CAPECITABINE","500 MG","84","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","30","Select","Select",""],["","54766082904","ANALPRAM-HC","LOT 0.025","59","Select","Select",""],["","54766072606","PRAMOSONE","LOT 0.025","59","Select","Select",""],["","00406996101","TEMAZEPAM","15 MG","30","Select","Select",""],["","00832059011","DIPHEN\/ATROP","TAB ","60","Select","Select",""],["","55111015430","ONDANSETRON","TAB 8MG","30","Select","Select",""],["","00591024005","LORAZEPAM","TAB 0.5MG","60","Select","Select",""],["","00168020230","CLINDAMYCIN","GEL 0.01","120","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","00591292754","LEVALBUTEROL","AER 45\/ACT","15","Select","Select",""],["","69452014420","BENZONATATE","CAP 200MG","21","Select","Select",""],["","50742061501","METOPROL","TAB 25MG ER","90","Select","Select",""],["","58160088552","FLUARIX","INJ 2020-21","0","Select","Select",""],["","77052001002","ALA-SCALP","LOT 0.02","30","Select","Select",""],["","00316014001","ALA","LOT 0.02","30","Select","Select",""],["","75834019701","HC","CRE 2.5-1%","-30","Select","Select",""],["","43684010010","SCALACORT","LOT 0.02","30","Select","Select",""],["","29300042101","AMITRIPTYLINE HCL","50 MG","30","Select","Select",""],["","68180063509","ATORVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","43547028810","BUPROPION HCL SR","100 MG","180","Select","Select",""],["","13668048450","MINOCYCLINE HCL","100 MG","60","Select","Select",""],["","72516003001","METOPROLOL SUCCINATE","25 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":""}]}]}