{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NITSIRHCRELYO E","gend":1,"add":"EHTUOS 0452RD SENIP NR","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1986-05-26","age":"","mstatus":"","insh":"3022110*10","cliId":"","pno":"34\/7572308-4","cno":"","email":"","ename":"","eno":"","pphy":"VACCARELLA, JOSEPH E MD","ppno":"757\/842-6180","pcpadd":"STE 101 1419 CEDAR ROAD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23322,"pcpcounty":"","pcpid":"","pcpname":"Cedar Road Medical Associates","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":["F90.9","F41.9","R41.0","S09.90XA","S06.5X1A","V91.89XA","S06.309A","S06.6X9A","S06.9X9A","R90.89","T68.XXXA","U07.1","S02.92XA","T42.4X1A","F32.9","S06.5X9A","T75.1XXA","S02.19XA","S02.40FA","S02.85XA","F10.120","R00.1","H11.32","T46.5X5A","Z78.1","T50.901A","R40.4","K90.0","F17.210","E87.6","R05.9","I49.8","I60.9","J84.03","R07.9","S02.402A","S02.842A","F90.0","L02.91","F32.1","R41.82","T40.2X1A","M54.30","R09.2","Z79.899","R40.2410","R00.0","M54.9","R53.83","F51.09","F10.239","F15.23","F15.188","F15.14","R06.02","F19.10","V62.84","F13.239","F15.280","F13.280","M54.5","F10.24","F15.24","F13.24","F10.280","F10.20","F10.10"],"date":["2020-09-01","2021-12-21","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2021-01-02","2021-01-02","2020-12-31","2021-01-02","2021-01-02","2021-01-02","2021-01-02","2021-12-14","2020-10-05","2020-12-30","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2020-12-28","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2020-12-30","2020-12-30","2020-12-31","2021-02-05","2021-02-05","2021-12-21","2021-12-21","2021-06-10","2021-10-31","2021-10-31","2020-05-22","2021-10-31","2021-10-31","2020-12-28","2021-12-14","2019-06-09","2019-06-09","2019-06-09","2019-06-12","2019-06-12","2019-06-12","2019-06-12","2019-06-07","2019-06-07","2019-06-07","2019-06-08","2019-06-08","2019-06-08","2019-06-08","2019-06-08","2019-06-08","2019-06-08","2019-06-08","2019-06-08","2019-09-26"],"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":[["","00527150537","AMPHET\/DEXTR","TAB 20MG","60","Select","Select",""],["","00378400505","ALPRAZOLAM","TAB 1MG","30","Select","Select",""],["","65862019301","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","10702001850","OXYCODONE","TAB 5MG","20","Select","Select",""],["","59746011306","PROCHLORPER","TAB 5MG","5","Select","Select",""],["","00555901467","LESSINA","TAB ","28","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","12","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","56","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","65862049001","QUETIAPINE","TAB 50MG","14","Select","Select",""],["","68382009810","PAROXETINE","TAB 20MG","14","Select","Select",""],["","00591333119","BUPROPN","TAB 150MG XL","14","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":""}]}]}