{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M   ATINASMAILLIW ","gend":1,"add":"EELIBUJ 03715171 TPA TS ","city":"NORFOLK","state":"VA","zip":"23523-9998","dob":"1971-10-10","age":"","mstatus":"","insh":"2838210*94","cliId":"","pno":"49\/7570035-9","cno":"757\/949-5300","email":"","ename":"","eno":"","pphy":"AKRAGORN, EKKARAT MD","ppno":"757\/410-2287","pcpadd":"112 GAINSBOROUGH SQUARE #100","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J20.8","U07.1","J44.9","J12.89","J96.01","J44.0","J44.1","E86.0","Z87.891","Z98.891","Z98.51","Z79.899","Z88.8","I95.9","M43.6","J40.","R51.","F90.9","G89.29","G43.909","L70.9","L30.9","R09.02","J06.9","N76.2","L70.0","R07.9","G47.01","F90.2","H43.399","R51.9","J02.9","K13.70","M79.604","L63.0","S80.861A","G44.209","J03.90","G43.009","R10.13","Z00.00","G47.00","R79.1","R32.","R06.02","R50.9","M47.812","E66.9","Z68.35","K29.70","R07.89","NO DATA","Z20.828","J43.9","R91.1","N30.00","B37.0","B94.8","R39.9","N30.01","Z01.419","K29.90","Z86.010","Z12.31","Z71.2"],"date":["2020-07-05","2022-05-31","2022-06-21","2020-07-14","2020-07-14","2020-07-04","2020-07-14","2020-07-04","2021-06-15","2020-07-04","2020-07-04","2020-07-04","2020-07-04","2020-07-08","2020-07-13","2022-05-31","2020-07-13","2020-07-13","2020-07-13","2021-01-20","2021-10-04","2021-10-04","2020-07-04","2020-07-04","2020-08-10","2020-09-17","2022-04-02","2020-10-15","2020-10-15","2021-05-27","2022-04-02","2022-03-01","2022-03-01","2022-04-02","2020-02-26","2020-05-19","2020-05-30","2020-09-02","2021-01-05","2022-04-11","2020-04-29","2020-09-02","2022-04-02","2022-11-07","2020-07-04","2020-07-04","2021-01-20","2021-01-20","2021-01-20","2022-04-11","2020-06-30","2020-06-30","2020-06-30","2022-05-31","2022-06-21","2021-07-07","2022-05-31","2022-05-31","2022-10-12","2021-06-12","2022-02-17","2022-03-09","2022-03-10","2022-06-21","2022-06-21"],"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":[["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","33332032101","AFLURIA","INJ 2021-22","0","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","59762040105","SUCRALFATE","TAB 1GM","56","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","224","Select","Select",""],["","00005200010","PREVNAR","INJ ","0","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00006483703","PNEUMOVAX","INJ 25\/0.5","0","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","59267102501","PFIZER","INJ ADLT RTU","0","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","42192080201","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","58160089052","FLUARIX","INJ 2022-23","0","Select","Select",""],["","49281040010","ADACEL","INJ ","0","Select","Select",""],["","51660033301","ARTHRTS","TAB 650MG","28","Select","Select",""],["","31722053405","METHOCARBAM","TAB 750MG","60","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","49281072010","FLUBLOK","INJ 2020-21","0","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","60","Select","Select",""],["","50111043303","TRAZODONE","TAB 50MG","30","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","65862001105","SERTRALINE","TAB 25MG","30","Select","Select",""],["","00536126812","ANTI-ITCH","LOT 0.5-0.5%","222","Select","Select",""],["","00187516245","RETIN-A","CRE 0.0005","45","Select","Select",""],["","00299591825","DIFFERIN","GEL 0.003","45","Select","Select",""],["","24470090960","BP","GEL 0.05","60","Select","Select",""],["","67877025145","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","66993094945","CLINDAMY\/BEN","GEL 1.2-5%","45","Select","Select",""],["","45802026337","CLINDAMYCIN","MIS 0.01","60","Select","Select",""],["","45802028034","BENZOYL","LIQ 5% WASH","237","Select","Select",""],["","00603233832","APAP\/CODEINE","TAB 300-30MG","30","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","20","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","CAP ","20","Select","Select",""],["","57664050318","TIZANIDINE","TAB 4MG","56","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","51991035578","RIZATRIPTAN","TAB 10MG","9","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","70756081115","NYSTAT\/TRIAM","OIN ","15","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","4","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":""}]}]}