{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NIMSAJHCIR E","gend":1,"add":"NIKSAG 7121J TPA DR S","city":"HENRICO","state":"VA","zip":"23238-9998","dob":"2001-06-10","age":"","mstatus":"","insh":"09600210*85","cliId":"","pno":"78\/4083674-4","cno":"804\/874-4763","email":"","ename":"","eno":"","pphy":"GWATHMEY, KELLY G MD","ppno":"804\/828-9350","pcpadd":"11958 W BROAD SREET","pcpcity":"HENRICO","pcpstate":"VA","pcpzip":23233,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","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":["G60.0","G62.9","F43.10","R26.89","S00.33XA","S00.511A","K03.81","R04.0","F41.9","Z20.822","B34.9","F41.1","J06.9","M62.81","R29.6","S02.5XXA"],"date":["2022-11-11","2022-11-11","2021-07-23","2022-11-11","2022-09-20","2022-09-20","2022-09-20","2022-09-20","2022-11-07","2022-06-03","2022-06-03","2022-10-17","2022-01-05","2022-11-11","2022-11-11","2022-09-20"],"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":[["","57237015035","FLUCONAZOLE","SUS 40MG\/ML","35","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","270","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","21","Select","Select",""],["","00121072104","FLUOXETINE","SOL 20MG\/5ML","1350","Select","Select",""],["","68180044102","CEPHALEXIN","SUS 250\/5ML","200","Select","Select",""],["","00093415579","AMOXICILLIN","SUS 250\/5ML","240","Select","Select",""],["","59651000823","AZITHROMYCIN","SUS 200\/5ML","45","Select","Select",""],["","68180065701","DOXYCYCLINE","SUS 25MG\/5ML","420","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","118","Select","Select",""],["","64380071307","BENZONATATE","CAP 200MG","20","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":""}]}]}