{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   TTEMMEREKCUR E","gend":0,"add":"AHC 9011RD SSOMT","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1975-05-14","age":"","mstatus":"","insh":"0551210*67","cliId":"","pno":"49\/7578885-2","cno":"757\/942-5888","email":"","ename":"","eno":"","pphy":"GONZALES, NORMAN M MD","ppno":"757\/413-7600","pcpadd":"SUITE 301 5320 PROVIDENCE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":"","pcpname":"SMG - Resource Pool","plan":"OHP","program":"MEDICAID","lob":"M4","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":["Z12.11","K64.0","Q43.8","N18.6","Z99.2","N25.81","I51.7","K56.2","I12.0","Z98.890","Z82.49","Z79.82","Z79.899","Z01.810"],"date":["2022-05-19","2022-05-19","2022-05-19","2022-10-01","2022-05-19","2022-02-01","2020-06-16","2022-05-19","2022-05-19","2022-05-19","2022-05-19","2022-05-19","2022-05-19","2020-06-16"],"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":[["","00378023201","FUROSEMIDE","TAB 80MG","180","Select","Select",""],["","00054000725","CALCITRIOL","CAP 0.25MCG","90","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","60","Select","Select",""],["","00536104710","SODIUM","TAB 650MG","90","Select","Select",""],["","23155000201","HYDRALAZINE","TAB 25MG","180","Select","Select",""],["","53746051101","SPIRONOLACT","TAB 25MG","60","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","270","Select","Select",""],["","68462044718","SEVELAMER","TAB 800MG","540","Select","Select",""],["","59779030602","CVS","POW ","238","Select","Select",""],["","49884012301","LABETALOL","TAB 200MG","360","Select","Select",""],["","65862020390","LOSARTAN","TAB 100MG","90","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","64380088304","CINACALCET","TAB 30MG","15","Select","Select",""],["","49483048112","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","00713068315","GENTAMICIN","CRE 0.001","15","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","45","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","43386031214","GAVILAX","POW ","510","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","13","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","2","Select","Select",""],["","49230064551","VELPHORO","CHW 500MG","90","Select","Select",""],["","59267102504","PFIZER","INJ ADLT RTU","0","Select","Select",""],["","58468002101","RENAGEL","TAB 800MG","540","Select","Select",""],["","00536730001","NEPHRO-VITE","TAB ","90","Select","Select",""],["","41100082071","MIRALAX","POW 3350 NF","510","Select","Select",""],["","60258016001","RENA-VITE","TAB ","30","Select","Select",""],["","58468013001","RENVELA","TAB 800MG","270","Select","Select",""],["","00904645760","DOK","CAP 100MG","60","Select","Select",""],["","50428310425","STOOL","CAP 100MG","180","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":""}]}]}