{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YTSIRKOEDHKUS J","gend":1,"add":"IHT 5814RIC ELTS","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1971-10-23","age":"","mstatus":"","insh":"3701110*83","cliId":"","pno":"75\/7573883-5","cno":"","email":"","ename":"","eno":"","pphy":"GOLDBERG, ERIC J MD","ppno":"757\/686-9300","pcpadd":"STE 305 3235 ACADEMY AVE","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23703,"pcpcounty":"","pcpid":"","pcpname":"TIDEWATER NEUROLOGISTS INC","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":["R41.82","R56.9","G47.30","R40.4","J96.01","J96.02","R65.10","D72.829","E87.2","G43.909","E11.65","F43.10","F34.1","F41.1","N17.9","R73.9","E78.5","D57.3","Z20.828","G89.29","M54.9","G47.33","E66.9","F12.90","G43.409","Z80.3","G40.409","F51.01","R09.02","E11.9","R35.0","S61.219A","F17.200","M25.562","M70.52","N30.00"],"date":["2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2020-12-04","2021-10-19","2021-10-19","2021-10-19","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2020-12-08","2020-12-02","2020-12-02","2020-12-02","2020-12-02","2020-12-24","2020-12-08","2020-12-02","2021-08-20","2021-08-20","2020-01-16","2020-12-02","2019-06-20","2019-06-20","2019-10-24"],"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":[["","68462012705","GABAPENTIN","TAB 800MG","30","Select","Select",""],["","00093321205","CLONAZEPAM","TAB 1MG","60","Select","Select",""],["","","ARIPIPRAZOLE","TAB 2MG","","Select","Select",""],["","00093506105","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","","METFORMIN","TAB 500MG","","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","60","Select","Select",""],["","","LEVETIRACETA","TAB 500MG","","Select","Select",""],["","60846050201","PYRIDIUM","TAB 200MG","6","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","51293081101","PHENAZOPYRID","TAB 200MG","6","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":""}]}]}