{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AMMESEKYS J","gend":1,"add":"TTAB 217EVA YRE","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1948-01-19","age":"","mstatus":"","insh":"01400210*11","cliId":"","pno":"77\/7571452-4","cno":"","email":"","ename":"","eno":"","pphy":"MAPANAO, VIVIAN MD","ppno":"757\/483-7100","pcpadd":"Bridge Road Family Medicine 4868 Br","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":"","pcpname":"Bridge Road Family Medicine","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H90.3","H93.293","I10.","E11.9","E78.5","E03.9","L29.9","R21.","E78.00","Z79.899","Z79.890","Z79.84","Z91.09","S80.811A","S80.812A","S30.810A","H90.5","Z12.31","E53.8","E55.9","F32.9","F41.1","G47.00","J30.9","J45.998","J01.90","I89.0","F41.9","M25.561","M25.562","M25.551","M16.0","M17.9","M70.61","G89.29","Z78.0","R60.0","Z12.9","R53.1","N39.46","Z74.09","M25.50"],"date":["2021-07-21","2021-07-21","2022-11-11","2022-11-11","2022-11-11","2022-11-11","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2021-07-09","2021-11-10","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2021-11-10","2021-11-10","2021-11-10","2020-01-10","2022-11-11","2019-01-15","2022-09-27","2022-09-27","2022-09-27","2022-09-27","2022-09-27","2022-09-27","2022-09-07","2022-04-20","2022-04-20","2022-04-20","2022-11-22","2022-11-11","2022-11-11","2022-11-11"],"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":[["","","FUROSEMIDE"," FUROSEMIDE ","30","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","","METOPROL"," METOPROL ","60","Select","Select",""],["","","MONTELUKAST"," MONTELUKAST ","30","Select","Select",""],["","","TRADJENTA"," TRADJENTA ","30","Select","Select",""],["","","LOSARTAN"," LOSARTAN ","30","Select","Select",""],["","","MELOXICAM"," MELOXICAM ","30","Select","Select",""],["","","LORAZEPAM"," LORAZEPAM ","30","Select","Select",""],["","","ASPIRIN"," ASPIRIN ","30","Select","Select",""],["","","ONETOUCH"," ONETOUCH ","25","Select","Select",""],["","","METFORMIN"," METFORMIN ","120","Select","Select",""],["","","PROAIR"," PROAIR ","17","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","00168000215","TRIAMCINOLON","CRE 0.005","60","Select","Select",""],["","","FEXOFENADINE"," FEXOFENADINE ","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","54","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","180","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","","NIFEDIPINE"," NIFEDIPINE ","30","Select","Select",""],["","","LEVOTHYROXIN"," LEVOTHYROXIN ","30","Select","Select",""],["","21922002107","PERMETHRIN","CRE 0.05","120","Select","Select",""],["","50111056003","TRAZODONE","TAB 50MG","30","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00536110301","ALCOHOL","PAD 0.7","100","Select","Select",""],["","62332004490","VALSARTAN","TAB 40MG","30","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00121077516","GG\/CODEINE","SOL 100-10\/5","120","Select","Select",""],["","00472073063","MICONAZOLE","CRE 0.02","45","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}