{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"S   ANILROLYAT ","gend":1,"add":"AP EGELLOC 5201922 TPA DVLB KR","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1949-12-01","age":"","mstatus":"","insh":"06300210*80","cliId":"","pno":"22\/7570750-2","cno":"757\/805-8320","email":"","ename":"","eno":"","pphy":"HUMADI, SAHIRA MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent 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":["R10.9","F41.9","F32.9","R12.","R42.","Z87.891","I10.","M25.512","L65.9","R76.8","M25.519","M16.9","W19.XXXA","Z48.02","K28.4","N17.9","D62.","NO DATA","M19.90","Z20.822","E78.5","I12.9","K21.9","E55.9","F10.20","H54.7","Z96.641","Z96.653","E89.0","Z98.84","K92.0","D50.0","R10.13","K28.9","Z98.0","T85.898A","D64.9","E03.9","L29.9","Z23.","R11.0","L73.2","J30.9","T78.40XA","Z86.010","K92.2","R63.4","R41.89","R26.81","I95.9","R29.898","R51.9","R11.2","R10.84","K80.50","M16.11","F17.210","Z96.651","L98.9","M62.81","G47.00","E66.9","E04.1","R19.7","R21.","J02.9","R06.00","I08.0","S01.01XA","M25.551","Z88.8","S06.9X9A","G89.29","R53.1","D50.9","L08.9","L89.90","R06.83"],"date":["2020-12-29","2021-02-05","2021-02-05","2020-04-07","2020-04-07","2021-11-26","2021-12-28","2021-09-09","2021-09-09","2021-09-09","2021-11-08","2021-11-18","2021-11-08","2021-11-08","2021-11-26","2021-12-06","2021-12-03","2021-12-03","2021-11-26","2021-11-26","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2021-11-26","2021-11-26","2021-11-26","2021-11-26","2021-12-03","2021-11-30","2021-11-30","2021-11-28","2021-12-28","2021-11-28","2021-12-20","2021-12-28","2021-12-28","2021-12-28","2021-12-28","2020-05-06","2020-07-16","2020-04-23","2020-10-18","2021-01-06","2021-12-03","2021-06-17","2021-02-05","2021-01-12","2021-06-17","2021-06-17","2021-07-22","2021-12-01","2021-12-01","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2020-10-30","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2020-07-16","2020-10-28","2020-10-28","2020-10-28","2021-11-28","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2020-12-29","2021-06-03","2021-11-29","2019-11-18","2019-12-06","2019-12-06"],"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":[["","","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","","LEVOTHYROXIN"," LEVOTHYROXIN ","30","Select","Select",""],["","","HYDROXYZ","CAP 25MG","","Select","Select",""],["","","VITAMIN","CAP 2000UNIT","","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG DR","","Select","Select",""],["","67877019705","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","","SUCRALFATE","TAB 1GM","","Select","Select",""],["","","HYDROCHLOROT","TAB 12.5MG","","Select","Select",""],["","50228018001","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","47682017513","ACETAMIN","TAB 500MG","100","Select","Select",""],["","","CITALOPRAM"," CITALOPRAM ","30","Select","Select",""],["","","PAIN"," PAIN ","90","Select","Select",""],["","","BENZONATATE"," BENZONATATE ","90","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","8","Select","Select",""],["","","ALLERGY"," ALLERGY ","30","Select","Select",""],["","","CALCIUM\/VT"," CALCIUM\/VT ","30","Select","Select",""],["","","APAP\/CODEINE"," APAP\/CODEINE ","6","Select","Select",""],["","","CEPHALEXIN"," CEPHALEXIN ","14","Select","Select",""],["","","SARNA"," SARNA ","222","Select","Select",""],["","","CALCIUM"," CALCIUM ","30","Select","Select",""],["","","FAMOTIDINE","TAB 40MG","","Select","Select",""],["","","CLINDAMYCIN","GEL 0.01","","Select","Select",""],["","","RA","TAB 10MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","HIBICLENS","LIQ 0.04","","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":""}]}]}