{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EB ELYKEDARGL","gend":0,"add":"NOREH 4093TC TNIOP ","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1997-03-02","age":"","mstatus":"","insh":"00400210*36","cliId":"","pno":"65\/7573029-3","cno":"","email":"","ename":"","eno":"","pphy":"PACHECO, PARIS MD","ppno":"757\/352-2030","pcpadd":"1168 FIRST COLONIAL RD STE 200","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454","pcpcounty":"","pcpid":"","pcpname":"Bayview Hospitalist","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.30","J98.4","R62.7","J30.81","Z71.3","F41.1","F84.0","NO DATA","F33.1","Z68.1","R63.6","R14.0","J30.0","J45.40","F32.9","H00.012","M54.2","H61.21","H61.20","F71."],"date":["2020-09-11","2021-04-19","2021-04-19","2021-04-19","2020-12-22","2021-09-23","2021-11-18","2021-11-18","2021-11-18","2020-11-10","2021-06-02","2020-02-19","2020-02-19","2021-04-19","2021-07-08","2021-11-01","2021-04-29","2021-10-27","2021-10-27","2021-11-18"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00054004641","IPRATROPIUM","SPR 0.0006","15","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00037024523","DYMISTA","SPR 137-50","23","Select","Select",""],["","00093321205","CLONAZEPAM","TAB 1MG","30","Select","Select",""],["","42192033901","HYOSCYAMINE","SUB 0.125MG","90","Select","Select",""],["","75834002012","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","9","Select","Select",""],["","60505095303","AZEL\/FLUTIC","SPR 137-50","23","Select","Select",""],["","78206012601","DULERA","AER 200-5MCG","13","Select","Select",""],["","00115175701","CYPROHEPTAD","TAB 4MG","90","Select","Select",""],["","00378808245","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","13107000130","MIRTAZAPINE","TAB 7.5MG","30","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","5","Select","Select",""],["","00574402435","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","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":""}]}]}