{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" M  EILAHNOTNROHT","gend":1,"add":"WEP 8203DAOR RET","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"2001-02-04","age":"","mstatus":"","insh":"8417110*04","cliId":"","pno":"4475751888","cno":7574488815,"email":"","ename":"","eno":"","pphy":"LIGHT, RYAN E MD","ppno":7573895370,"pcpadd":"STE 100 1100 VOLVO PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320-9998","pcpcounty":"","pcpid":"","pcpname":"GREENBRIER 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":["N39.0","F41.1","Z13.220","Z13.29","N30.00","J06.9","D48.5","D22.39","D49.2","K59.00","R10.31","R10.9","Z87.19","Z90.49","R11.0","R10.33","K31.89","R10.13","Z87.11"],"date":["2022-01-06","2023-01-12","2023-01-12","2023-01-12","2022-03-01","2023-03-26","2022-05-27","2022-05-26","2022-05-26","2023-05-24","2023-05-24","2023-05-10","2023-05-10","2023-05-10","2023-05-10","2023-05-08","2023-05-31","2023-05-31","2023-05-31"],"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":[["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00378334053","XULANE","DIS 150-35","12","Select","Select",""],["","50580064602","RHINOCORT","SUS ALLERGY","8","Select","Select",""],["","69842000101","BUDESONIDE","SUS 32MCG","8","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","14","Select","Select",""],["","60432027516","BROM\/PSE\/DM","SYP ","120","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","CAP ","20","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","13668010790","RABEPRAZOLE","TAB 20MG","60","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","2","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","6","Select","Select",""],["","43598075201","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","60505384901","CELECOXIB","CAP 200MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","33342002208","LEVOFLOXACIN TAB","500MG","5","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","00143992701","CIPROFLOXACN TAB","250MG","10","Select","Select",""],["","58160089052","FLUARIX QUAD INJ","2022-23","0","Select","Select",""],["","55111029198","SUMATRIPTAN TAB","25MG","30","Select","Select",""],["","00832605211","DICYCLOMINE HCL","20 MG","30","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","64380071207","BENZONATATE","100 MG","30","Select","Select",""],["","42858010201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","10","Select","Select",""],["","16571040250","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA","90 MCG","18","Select","Select",""],["","65862052790","VENLAFAXINE CAP","37.5 ER","30","Select","Select",""],["","29033000301","SUCRALFATE","1 G","28","Select","Select",""],["","65162068210","PHENAZOPYRIDINE HCL","200 MG","6","Select","Select",""],["","16714043901","NITROFURANTOIN MONO-MACRO","100 MG","14","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":""}]}]}