{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L   DRAWDEIII YLLEK ","gend":0,"add":"ASEHC 5072DVLB EKAEP","city":"NORFOLK","state":"VA","zip":"23509-9998","dob":"1969-02-17","age":"","mstatus":"","insh":"15500210*92","cliId":"","pno":"22\/4089463-6","cno":"804\/226-3649","email":"","ename":"","eno":"","pphy":"NEWBY, JAMES E MD","ppno":"757\/627-6892","pcpadd":"STE 220 930 MAJESTIC AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":"","pcpname":"Primary Care Specialists","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":["F33.42","F14.20","F33.1","F70.","F43.10","G47.33","Z72.821","G47.10","R06.83","F41.9","F32.9","F39.","F32.3","I10.","E66.01","Z72.0","Z68.42","R00.2","M79.652","Z23.","G44.209","F17.210","H53.149","M25.552","I25.10","K76.0","M54.9","G56.01","B35.1","Z12.5","E78.00","I25.83","I15.9","R94.31","Z99.89"],"date":["2021-03-17","2021-03-17","2020-01-22","2020-01-22","2020-01-22","2021-06-22","2020-04-01","2020-04-01","2020-04-01","2020-04-01","2020-04-01","2020-04-01","2020-04-01","2022-08-27","2020-04-20","2020-10-03","2021-06-22","2020-10-22","2020-10-08","2021-07-21","2022-08-27","2022-08-27","2022-08-27","2020-10-03","2021-06-22","2021-06-22","2020-04-02","2020-04-02","2020-04-02","2021-06-22","2020-10-22","2020-04-20","2020-07-09","2020-07-22","2020-01-07"],"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":[["","16729021815","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","69097094705","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","68382009205","CARVEDILOL","TAB 3.125MG","60","Select","Select",""],["","68382065001","ISOSORB","TAB 30MG ER","90","Select","Select",""],["","00904679480","ASPIRIN","CHW 81MG","30","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","30","Select","Select",""],["","00186077760","BRILINTA","TAB 90MG","60","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00406012401","HYDROCO\/APAP","TAB 7.5-325","6","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","12","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","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":""}]}]}