{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REFINNEJELPMAS ","gend":1,"add":"SORC 8046TC SDNIWS","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1986-02-17","age":"","mstatus":"","insh":"0586110*39","cliId":"","pno":"26\/7579476-0","cno":"757\/549-4796","email":"","ename":"","eno":"","pphy":"BEITINJANEH, FIRAS MD","ppno":"757\/461-5400","pcpadd":"6161 KEMPSVILLE CIRCLE SUITE 315","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"pcpcounty":"","pcpid":"","pcpname":"Neurology Specialists, Ltd.","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S52.592A","F33.2","F90.2","F41.1","G43.019","G40.219","G40.109","F32.9","G47.419","F41.0","I10.","K21.9","Z87.440","Z79.899","Z90.49","Z88.8","Z88.5","Z91.013","Z91.041","Z87.820","Z87.442","Z23.","R56.9","S62.639A","V54.12","M25.532","Z01.419","Z12.39","S52.552A"],"date":["2020-01-09","2021-10-29","2021-10-29","2021-10-29","2021-07-13","2021-07-13","2020-10-26","2021-08-03","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2021-05-01","2020-02-04","2019-12-18","2019-06-05","2019-06-05","2019-12-15"],"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":[["","","METOPROL"," METOPROL ","30","Select","Select",""],["","","APTIOM"," APTIOM ","60","Select","Select",""],["","","LAMOTRIGINE"," LAMOTRIGINE ","60","Select","Select",""],["","","VENLAFAXINE"," VENLAFAXINE ","90","Select","Select",""],["","","ALPRAZOLAM"," ALPRAZOLAM ","30","Select","Select",""],["","","ESZOPICLONE"," ESZOPICLONE ","30","Select","Select",""],["","00555097202","AMPHET\/DEXTR","TAB 10MG","60","Select","Select",""],["","","FOLIC","TAB 1000MCG","","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","2","Select","Select",""],["","","METOPROLOL","TAB 50MG ER","","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","20","Select","Select",""],["","","PROMETHEGAN"," PROMETHEGAN ","2","Select","Select",""],["","","HIBICLENS"," HIBICLENS ","236","Select","Select",""],["","","BUT\/APAP\/CAF"," BUT\/APAP\/CAF ","20","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","CLONAZEP","TAB 0.5MG","","Select","Select",""],["","","SSD","CRE 0.01","","Select","Select",""],["","","BUT\/ASA\/CAFF","CAP ","","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","","ZOLPIDEM","TAB 10MG","","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":""}]}]}