{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B NIVEKYELSAE","gend":0,"add":"CAEB 504DAOR NO","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"1974-12-02","age":"","mstatus":"","insh":"40400210*65","cliId":"","pno":"27\/7576210-4","cno":"757\/215-6756","email":"","ename":"","eno":"","pphy":"AFSHARCHI, FOROOZAN MD","ppno":"757\/983-5110","pcpadd":"SUITE 103 4124 CHESAPEAKE SQUARE BL","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"","pcpname":"SENTARA MEDICAL GROUP","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K64.8","E61.1","G25.81","E78.00","Z20.828","R06.02","R50.9","J40.","K64.3","F33.2","F43.10","F90.1","G47.00","I10.","R05.","D64.9","Z13.220","K64.5","D50.0","K64.9","F90.9","F41.9","M79.675","U07.1","D50.9","R53.83","Z13.1","Z11.59","L02.31","Z79.899","Z87.891","S39.012A","L73.9","Z71.9","F17.200","H66.002","F17.210","NO DATA","K62.5","E78.5","E66.9","Z72.0","K62.1","K64.4","Z87.19","Z88.8","Z23.","E78.2","F90.2","Z01.812","Z20.822","K63.5","F39.","M51.36","G89.4","Z68.37","F43.12","L02.821","L20.82","B96.89","H40.52X4","H43.391","Z87.2","E66.01","R03.0","Z86.79","F32.9","S90.31XA","F41.1","R06.83","J34.2"],"date":["2021-07-03","2021-06-04","2021-06-04","2021-06-04","2021-06-18","2021-06-18","2021-06-18","2021-06-18","2021-07-03","2021-12-08","2021-12-08","2021-08-26","2020-06-26","2021-08-30","2020-06-26","2020-06-26","2021-05-04","2021-07-07","2021-07-07","2021-04-16","2021-04-16","2021-04-16","2020-06-11","2021-10-20","2021-05-12","2021-05-04","2021-05-04","2021-05-04","2021-08-30","2021-08-30","2021-08-30","2021-11-13","2021-01-26","2021-01-26","2021-06-18","2021-06-18","2021-07-03","2021-06-18","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-05-12","2021-05-12","2021-07-03","2021-07-03","2020-10-02","2020-10-02","2020-10-05","2021-05-08","2021-05-08","2021-05-12","2019-06-11","2019-03-27","2019-03-27","2019-03-29","2019-08-20","2019-09-03","2019-09-03","2019-09-03","2019-11-04","2019-02-13","2019-02-21","2019-02-21","2019-03-29","2019-02-21","2019-02-21","2019-11-14","2019-02-23","2019-03-29","2019-03-29"],"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":[["","","AMPHET\/DEXTR"," AMPHET\/DEXTR ","90","Select","Select",""],["","","ROSUVASTATIN"," ROSUVASTATIN ","30","Select","Select",""],["","","ALPRAZOLAM"," ALPRAZOLAM ","90","Select","Select",""],["","33342020807","PRAMIPEXOLE","TAB 0.375 ER","30","Select","Select",""],["","","PAROXETINE"," PAROXETINE ","45","Select","Select",""],["","70436005902","BUPROPION","TAB 150MG SR","180","Select","Select",""],["","","FEROSUL","TAB 325MG","","Select","Select",""],["","","TRAZODONE"," TRAZODONE ","60","Select","Select",""],["","","BENZTROPINE"," BENZTROPINE ","30","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","45802056202","CLINDAMYCIN","SOL 0.01","60","Select","Select",""],["","68001000501","METHYLPRED","TAB 4MG","21","Select","Select",""],["","51660099530","COLESEVELAM","PAK 3.75","30","Select","Select",""],["","","ROPINIROLE","TAB 5MG","","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","68001023803","CLONIDINE","TAB 0.2MG","30","Select","Select",""],["","00406012310","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","00603533932","PREDNISONE","TAB 20MG","21","Select","Select",""],["","","AZITHROMYCIN","TAB 500MG","","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","","ELIDEL"," ELIDEL ","100","Select","Select",""],["","","ATROPINE"," ATROPINE ","5","Select","Select",""],["","","BRIMONIDINE"," BRIMONIDINE ","5","Select","Select",""],["","","TIMOLOL"," TIMOLOL ","5","Select","Select",""],["","","SILVER"," SILVER ","400","Select","Select",""],["","","PIMECROLIMUS"," PIMECROLIMUS ","100","Select","Select",""],["","","ALPHAGAN"," ALPHAGAN ","5","Select","Select",""],["","","BESIVANCE"," BESIVANCE ","5","Select","Select",""],["","","MOXIFLOXACIN"," MOXIFLOXACIN ","3","Select","Select",""],["","","PROLENSA"," PROLENSA ","3","Select","Select",""],["","","DUREZOL"," DUREZOL ","5","Select","Select",""],["","","ISOPTO"," ISOPTO ","5","Select","Select",""],["","","QUETIAPINE"," QUETIAPINE ","30","Select","Select",""],["","","FLUOROMETHOL"," FLUOROMETHOL ","5","Select","Select",""],["","","TACROLIMUS"," TACROLIMUS ","100","Select","Select",""],["","","DOXYCYC"," DOXYCYC ","20","Select","Select",""],["","","GABAPENTIN"," GABAPENTIN ","90","Select","Select",""],["","","TRIAMCINOLON"," TRIAMCINOLON ","30","Select","Select",""],["","","HYDROCHLOROT"," HYDROCHLOROT ","30","Select","Select",""],["","","FML"," FML ","5","Select","Select",""],["","","SILDENAFIL"," SILDENAFIL ","9","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","45","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","90","Select","Select",""],["","","CLOBETASOL"," CLOBETASOL ","59","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","3","Select","Select",""],["","","DULOXETINE"," DULOXETINE ","30","Select","Select",""],["","","BETAMETH"," BETAMETH ","60","Select","Select",""],["","","FENOFIBRATE"," FENOFIBRATE ","30","Select","Select",""],["","","SMZ\/TMP"," SMZ\/TMP ","30","Select","Select",""],["","","ARIPIPRAZOLE"," ARIPIPRAZOLE ","30","Select","Select",""],["","","METAXALONE"," METAXALONE ","30","Select","Select",""],["","","HYD","SUS 10-8\/5ML","","Select","Select",""],["","","DOCUSATE","CAP 100MG","","Select","Select",""],["","","GNP","LIQ DM","","Select","Select",""],["","","INDOMETHACIN","CAP 50MG","","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":""}]}]}