{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ECIRTAPRENNOB N","gend":1,"add":"NOSWAC E 113502 TPA TS ","city":"HOPEWELL","state":"VA","zip":23860,"dob":"1988-01-07","age":"","mstatus":"","insh":"04200210*08","cliId":"","pno":"92\/4080392-5","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"804\/469-3731","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23860,"pcpcounty":"","pcpid":"","pcpname":"SOUTHERN DOMINION HEALTH SYSTEM INC","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"APT#205","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":["J06.9","J20.9","J01.00","H66.001","B37.3","K02.3","J45.31","K08.89","M25.512","R05.","R03.0","N76.4","E11.9","Z79.84","J45.20","H00.022","Z32.02","J45.41","J45.21","R05.9","Z20.822","F17.210","Z68.36","E66.9","J02.9"],"date":["2022-04-16","2020-02-18","2020-06-03","2020-06-03","2020-06-03","2019-08-18","2019-01-14","2022-06-14","2019-10-12","2021-05-01","2019-10-12","2021-05-01","2021-05-01","2021-05-01","2022-04-16","2022-10-17","2022-10-17","2022-10-17","2022-03-08","2022-03-08","2022-03-08","2022-03-08","2022-03-08","2022-03-08","2022-06-14"],"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":[["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00378718705","METFORMIN","TAB 1000MG","60","Select","Select",""],["","53885099425","ONETOUCH","TES ULTRA BL","25","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","OFLOXACIN","DRO 0.3% OP","","Select","Select",""],["","00527293437","PREDNISONE","TAB 20MG","21","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","30","Select","Select",""],["","65702061710","ACCU-CHEK","KIT GUIDE","1","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","20","Select","Select",""],["","13107005999","APAP\/CODEINE","TAB 300-30MG","15","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","118","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","60505014202","GLIPIZIDE","TAB 10MG","180","Select","Select",""],["","50458014090","INVOKANA","TAB 100MG","90","Select","Select",""],["","","LANCET","MIS THIN 30G","","Select","Select",""],["","00555901258","NORTREL","TAB 39270","84","Select","Select",""],["","","CIPRODEX","SUS 0.3-0.1%","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","","BROM\/PSE\/DM","SYP ","","Select","Select",""],["","","DOXYCYC","TAB 100MG","","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":{"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":""}]}]}