{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"V HNIDEL TEI","gend":0,"add":"YAT 5062DAOR ROL","city":"CHESAPEAKE","state":"VA","zip":"23321-9998","dob":"1985-09-11","age":"","mstatus":"","insh":"9430210*17","cliId":"","pno":"1875739636","cno":"","email":"","ename":"","eno":"","pphy":"LE, DAU T MD","ppno":7576718746,"pcpadd":"SUITE 104 5444 VIRGINIA BEACH BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23462-9998","pcpcounty":"","pcpid":"","pcpname":"DAU T LE MD","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":["M54.14","R53.83","Z20.5","G47.00","Z20.822","B34.9","Z20.828","R62.7","G47.33","E11.9","M54.50","M43.16","Z00.01","B18.1","H10.13","K59.00"],"date":["2022-02-17","2022-08-11","2022-08-11","2022-10-31","2022-08-30","2022-08-30","2022-01-07","2022-08-02","2022-08-02","2022-08-02","2022-02-16","2022-02-16","2022-06-16","2023-05-05","2023-05-05","2023-05-05"],"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":[["","10702001050","HYDROXYZ","TAB 10MG","60","Select","Select",""],["","68462019217","MOMETASONE","CRE 0.001","45","Select","Select",""],["","65162044210","MECLIZINE","TAB 25MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","58160088552","FLUARIX","INJ 2020-21","0","Select","Select",""],["","00093321930","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","90","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65162018910","NAPROXEN TAB","375MG","60","Select","Select",""],["","70710111001","CYPROHEPTAD TAB","4MG","30","Select","Select",""],["","24208083060","NEOMYCIN-POLYMYXIN-DEXAMETH","0.1 %","5","Select","Select",""],["","69097084507","CYCLOBENZAPR TAB","5MG","60","Select","Select",""],["","00591252001","CHLORZOXAZON TAB","500MG","30","Select","Select",""],["","57664050083","MIRTAZAPINE TAB","30MG","30","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","13668013601","ESCITALOPRAM TAB","10MG","90","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","14","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","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":""}]}]}