{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NYRAKREKCUR A","gend":1,"add":"KWAHYKS 2231201 TPA RIC ","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1991-12-03","age":"","mstatus":"","insh":"34300210*17","cliId":"","pno":"34\/7578003-4","cno":"","email":"","ename":"","eno":"","pphy":"BEDARD, TARA L PA","ppno":"757\/252-9800","pcpadd":"1380 TUSCANY DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23456","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Nimmo","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":["Z76.0","F43.25","Z00.00","F81.9","N92.6","F43.23","M79.661","F41.1","R11.2","M41.9","Z88.0","Z91.048","Z88.8","Z91.018","F41.9","F32.0","V58.89","R46.89","R44.0","R10.11","R11.0","R10.32","Z20.822","F43.24","H61.22","L72.3","R51.9","M75.31"],"date":["2021-07-08","2021-12-26","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-12-23","2020-08-22","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-04-29","2021-05-05","2021-10-23","2021-01-14","2021-01-14","2021-01-14"],"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":[["","65862059501","DIVALPROEX","TAB 500MG ER","30","Select","Select",""],["","68645052254","SERTRALINE","TAB 50MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00274230015","ERO","SOL REMOVAL","15","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","16714079903","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00591530710","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","57896086406","MELATONIN","TAB 3MG","30","Select","Select",""],["","49035086202","EQ","SOL 6.5% OT","15","Select","Select",""],["","13107008301","LORAZEPAM","TAB 0.5MG","10","Select","Select",""],["","71093013502","QUETIAPINE","TAB 50MG ER","30","Select","Select",""],["","37205045705","EAR","DRO 6.5% OT","15","Select","Select",""],["","50580075201","ZYRTEC","TAB 10MG","30","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":""}]}]}