{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AC ANIGOLLITS","gend":1,"add":"TTEKHCTIP 002431 MR DR EL","city":"SUFFOLK","state":"VA","zip":23434,"dob":"1988-06-24","age":"","mstatus":"","insh":"5383110*42","cliId":"","pno":"99\/7574915-7","cno":"","email":"","ename":"","eno":"","pphy":"Humadi, Sahira","ppno":"757\/446-5955","pcpadd":"825 Fairfax Avenue Suite 118","pcpcity":"Norfolk","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","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":["F41.9","F32.9","E11.65","E11.42","M79.89","I10.","R80.9","Z23.","S99.922A","M25.562","R60.0","E88.09","R51.9","E11.8","R60.9","M79.671","M79.672","E11.49","R07.89","R07.9","R52.","R00.0","Z79.4","Z30.9","E87.6","E11.9","G90.9","J45.909","F41.8","M79.662","S91.312A","E10.40","T14.8XXA","M25.561","N30.00","N17.9","L02.214","M25.572"],"date":["2020-10-21","2020-10-21","2021-11-30","2021-10-20","2021-10-20","2021-12-01","2021-12-01","2020-06-12","2020-07-02","2020-11-17","2021-11-30","2021-12-01","2021-11-30","2021-11-30","2021-12-01","2021-10-05","2021-10-05","2021-10-05","2021-11-30","2021-11-30","2021-11-30","2021-11-30","2020-04-23","2020-07-02","2021-12-01","2021-12-01","2021-12-01","2021-12-01","2021-12-01","2021-06-04","2020-07-08","2020-07-08","2019-02-13","2019-02-13","2019-05-24","2019-05-24","2019-05-24","2019-02-13"],"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":[["","","INSULIN","MIS 0.3\/30G","","Select","Select",""],["","","LISINOPRIL","TAB 10MG","","Select","Select",""],["","","GABAPENTIN","CAP 300MG","","Select","Select",""],["","","HUMULIN","INJ 70\/30KWP","","Select","Select",""],["","","CITALOPRAM","TAB 20MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","69238148901","BUMETANIDE","TAB 0.5MG","30","Select","Select",""],["","","METFORMIN","TAB 500MG ER","","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","50742026001","NIFEDIPINE","TAB 30MG ER","30","Select","Select",""],["","","TRUE","TES GLUCOSE","","Select","Select",""],["","","ONETOUCH","TES ULTRA BL","","Select","Select",""],["","","OXYCOD\/APAP"," OXYCOD\/APAP ","18","Select","Select",""],["","31722070190","LOSARTAN","TAB 50MG","30","Select","Select",""],["","00378456177","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","","LANTUS","INJ 100\/ML","","Select","Select",""],["","11822365670","ACETAMIN","TAB 500MG","30","Select","Select",""],["","","CEPHALEXIN"," CEPHALEXIN ","20","Select","Select",""],["","","SERTRALINE","TAB 50MG","","Select","Select",""],["","","NOVOLIN","INJ 70\/30","","Select","Select",""],["","","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","","BD  PEN NEEDL","MIS 31GX5MM","","Select","Select",""],["","","DULOXETINE","CAP 30MG","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","LEVOFLOXACIN","TAB 750MG","","Select","Select",""],["","","ASPIRIN","CHW 81MG","","Select","Select",""],["","","NOVOLIN70\/30","INJ RELION","","Select","Select",""],["","","ALBUTEROL","AER HFA","","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":""}]}]}