{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ALIEHSSWERDNA A","gend":1,"add":"ALLECRAM 112634 TPA DR ","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1957-09-11","age":"","mstatus":"","insh":"23200210*11","cliId":"","pno":"48\/7576715-8","cno":"757\/325-0609","email":"","ename":"","eno":"","pphy":"FRISCO, SHAWNITA A MD","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","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":["G47.33","E11.59","I15.2","I10.","R51.","E11.9","E11.69","D64.9","L29.9","N62.","E78.5","Z79.899","M72.2","M24.572","M24.571","M21.6X2","M21.6X1","M79.672","F33.1","Z51.81","E66.9","Z11.59","M13.0","F81.0","Z86.69","Z00.00","Z23.","N95.1","Z78.0","K59.01"],"date":["2021-01-13","2022-10-10","2022-10-10","2021-12-07","2020-03-15","2022-10-10","2021-12-07","2021-08-18","2022-04-06","2022-06-01","2021-12-07","2021-11-08","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2021-12-09","2022-10-10","2021-05-19","2020-09-02","2022-10-10","2021-12-07","2021-12-07","2020-03-16","2022-10-10","2022-10-10","2022-10-10","2022-10-10","2022-03-09"],"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":[["","55111073390","VALSARTAN","TAB 160MG","90","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","30","Select","Select",""],["","68180021709","LOSARTAN\/HCT","TAB 100-25","90","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","31722052110","HYDRALAZINE","TAB 50MG","90","Select","Select",""],["","00093506101","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","90","Select","Select",""],["","66715083035","REPLENS","GEL VAG","35","Select","Select",""],["","00904693181","PEG","POW ","30","Select","Select",""],["","68382009706","PAROXETINE","TAB 10MG","30","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","18","Select","Select",""],["","00054074287","ALBUTEROL","AER HFA","7","Select","Select",""],["","42806071405","BENZONATATE","CAP 100MG","30","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","65862000801","METFORMIN","TAB 500MG","180","Select","Select",""],["","53746054201","POT  CHLORIDE","CAP 10MEQ ER","90","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","00904595961","CLINDAMYCIN","CAP 150MG","30","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}