{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AIROYOTALROLYAT M  ","gend":1,"add":"GNIW 3341EVA DLEIF","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1987-11-12","age":"","mstatus":"","insh":"1297110*42","cliId":"","pno":"73\/7578955-6","cno":"757\/376-5598","email":"","ename":"","eno":"","pphy":"MORGAN, AIMEE M PA","ppno":"757\/413-7600","pcpadd":"STE 301 5320 PROVIDENCE RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Providence Road","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":["R23.8","F41.9","W57.XXXA","M25.80","M79.671","M79.672","J30.1","F33.1","F90.2","J30.2","K21.9","L73.2","M54.42","M54.41","M46.1","J30.89","R09.89","L29.9","M54.16","M51.26","Z20.822","E86.0","R51.9","R11.2","F41.1","F90.1","Z02.89","R00.2","E78.01","R07.89","F17.200","M54.9","G89.29","R29.898","E78.5","B35.4","R10.13","R19.7","R31.9","K52.9","J01.91","R07.2","F90.9","E78.00","Z00.00","Z86.19","R51.","F98.8","E78.2","R07.9","N64.4","L70.9","M47.816","Z72.0","J06.9","H93.293","Z82.49","Z32.02","Z30.017","Z30.46","G44.219","M12.9","R42.","R21."],"date":["2019-04-01","2021-10-04","2019-04-01","2019-07-31","2019-07-31","2019-07-31","2020-09-21","2021-10-04","2021-10-04","2020-02-25","2021-06-24","2021-07-06","2021-07-31","2021-07-31","2021-12-14","2020-06-26","2020-06-26","2020-06-26","2021-12-08","2021-11-02","2021-11-20","2021-11-24","2021-12-22","2021-11-20","2019-05-14","2019-04-23","2020-02-13","2020-09-04","2020-09-04","2020-09-04","2021-12-22","2019-05-02","2021-12-22","2019-09-10","2020-07-13","2019-09-10","2020-08-31","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-07-07","2020-06-01","2020-06-01","2021-12-22","2021-01-13","2020-07-13","2021-01-13","2021-12-22","2020-07-13","2020-07-13","2020-07-13","2021-11-10","2019-12-23","2019-11-23","2020-02-06","2021-06-28","2019-10-16","2019-10-16","2019-10-16","2021-01-13","2021-08-04","2021-11-24","2021-12-22"],"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":[["","","ALPRAZOLAM"," ALPRAZOLAM ","60","Select","Select",""],["","","AMPHET\/DEXTR"," AMPHET\/DEXTR ","60","Select","Select",""],["","","CITALOPRAM"," CITALOPRAM ","30","Select","Select",""],["","","TRIAMCINOLON"," TRIAMCINOLON ","15","Select","Select",""],["","","TRAZODONE"," TRAZODONE ","30","Select","Select",""],["","","CLINDAMYCIN"," CLINDAMYCIN ","40","Select","Select",""],["","","CLOTRIM\/BETA"," CLOTRIM\/BETA ","30","Select","Select",""],["","","METHYLPRED"," METHYLPRED ","21","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","","CODEINE\/GG"," CODEINE\/GG ","120","Select","Select",""],["","","FLUCLVX"," FLUCLVX ","0","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","","CHANTIX","PAK 0.5& 1MG","","Select","Select",""],["","","FLUOCINONIDE","CRE 0.0005","","Select","Select",""],["","","AZELASTINE","SPR 0.001","","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","FLUZONE","INJ 2020-21","","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":""}]}]}