{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GI ADIAZHTEBZEREPSAISEL","gend":1,"add":"EC 2 1 3122 # TS RAD","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1973-01-14","age":"","mstatus":"","insh":"3572210*05","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"WEBSTER, ELIZABETH MD","ppno":"757\/975-5200","pcpadd":"7401 WARWICK BLVD","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23607,"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":["G44.009","G56.23","M50.321","M50.322","M50.323","I20.9","R06.09","R00.2","M77.50","Z12.31","J45.20","D64.9","R51.9","J45.21","B34.9","R20.2","I49.1","I49.3","U07.1","J02.9","Z91.040","Z91.018","Z91.09","Z91.02","R06.2","M25.531","M25.532","M75.41","V58.89","M25.511","M54.32","G89.29","Z12.39","M54.16","M47.896","M72.2","N83.292","N93.9","NO DATA","G56.03","M79.672","M77.31","R03.0","Z91.048","R53.1","J06.9","S93.601A","S43.81XA","I47.1","N95.1","M54.5","M79.671","G54.0","R23.3","D25.9","R35.0","Z12.4","M85.59","R07.9","K58.0","M75.101"],"date":["2020-09-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-07-20","2021-07-23","2022-10-14","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2022-05-06","2022-09-07","2022-09-07","2021-04-28","2022-10-28","2022-10-28","2022-01-01","2022-01-01","2022-09-07","2022-05-06","2022-09-07","2022-09-07","2022-09-07","2022-10-11","2022-10-11","2022-11-10","2022-10-11","2022-10-04","2021-03-04","2020-11-23","2020-11-23","2020-12-07","2021-09-09","2021-09-14","2020-06-29","2020-06-29","2021-09-09","2021-09-09","2021-10-25","2021-10-25","2022-05-06","2022-05-06","2022-05-06","2022-01-01","2022-03-03","2022-08-01","2022-10-28","2021-03-04","2021-03-04","2022-03-03","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2020-05-19","2021-04-30","2021-07-23","2021-09-14","2022-11-10"],"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":[["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","49035061247","ALLERGY","TAB 10MG","28","Select","Select",""],["","16714089802","LORATADINE","TAB 10MG","28","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","43","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","68382056410","METOPROL","TAB 25MG ER","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","4","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","12","Select","Select",""],["","57664037708","TRAMADOL","TAB 50MG","60","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","57237001760","DULOXETINE","CAP 20MG","60","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":""}]}]}