{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AIRAMNOSTAW","gend":1,"add":"D YHTAC 82203 TPA R","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1987-01-11","age":"","mstatus":"","insh":"4725110*07","cliId":"","pno":"25\/7573269-8","cno":"","email":"","ename":"","eno":"","pphy":"HUSEN, SRIE D MD","ppno":"757\/594-1850","pcpadd":"STE 100 11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Port Warwick","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":["R10.84","R11.2","R10.9","L70.0","L81.0","L21.8","S90.01XA","S90.31XA","S33.5XXA","N94.5","N92.0","R51.9","Z30.011","Z86.2","N89.8","F41.9","R89.5","G43.809","Z00.00","Z13.220","R05.","E78.2","B35.1","L60.3","L85.3","D23.9","Z71.9","R10.2","F43.23","F41.1"],"date":["2021-07-19","2021-07-19","2021-07-19","2021-10-14","2020-10-20","2020-10-20","2020-01-12","2020-01-12","2020-01-12","2020-05-08","2020-07-13","2021-01-26","2020-11-30","2020-11-30","2021-11-17","2021-12-20","2020-07-13","2021-01-15","2021-01-26","2021-01-26","2021-06-29","2021-06-29","2021-11-04","2021-11-04","2021-11-04","2021-10-14","2021-10-14","2020-04-21","2019-07-25","2019-08-05"],"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":[["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","","TRI-SPRINTEC","TAB ","","Select","Select",""],["","45802050701","CLINDAMY\/BEN","GEL 1-5%","25","Select","Select",""],["","00378510093","ITRACONAZOLE","CAP 100MG","42","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","","OB","CAP PETITE","","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00187517245","RETIN-A","GEL 0.0001","45","Select","Select",""],["","53489032801","SPIRONOLACT","TAB 50MG","30","Select","Select",""],["","","TAZORAC","CRE 0.0005","","Select","Select",""],["","51672128901","NYSTATIN","CRE 100000","15","Select","Select",""],["","66530025645","TRETINOIN","GEL 0.0001","45","Select","Select",""],["","","AZITHROMYCIN","TAB 500MG","","Select","Select",""],["","","CICLOPIROX","SHA 0.01","","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","","FEROSUL","TAB 325MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","MINOCYCLINE","CAP 100MG","","Select","Select",""],["","","HALOBETASOL","OIN 0.0005","","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","","BUT\/APAP\/CAF","CAP ","","Select","Select",""],["","","FERROUS","TAB 325MG","","Select","Select",""],["","67405065105","DOXYCYCL","CAP 100MG","30","Select","Select",""],["","","NYSTAT\/TRIAM","CRE ","","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":""}]}]}