{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A INOTYNOHTN","gend":1,"add":"IS 5631RD NOM","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1971-05-20","age":"","mstatus":"","insh":"5526210*74","cliId":"","pno":"34\/7571831-6","cno":"757\/436-1381","email":"","ename":"","eno":"","pphy":"SAMUELS, GARFIELD HUE MD","ppno":"757\/518-8823","pcpadd":"4452 CORPORATION LN STE 300","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"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":["H93.13","H93.293","H93.299","C50.911","C80.1","NO DATA","E78.5","G47.33","I10.","K51.90","R10.9","Z87.09","E78.00","R31.29","Z12.11","Z80.0","K64.0","R07.89","Z00.00","C50.411","Z17.0","Z51.12","R93.1","Z85.3","R22.2","K51.00","R05.","I07.1","I50.30","I51.89","Z11.59","R39.9","K51.40","G47.30","Z88.8","Z91.040","E55.9","Z98.890","Z90.49","Z88.5","Z79.899","Z82.49","Z83.49","Z01.419","Z12.4","Z90.710","Z01.89","R51.9","N64.4","H16.223","H52.13","H52.221","H52.4","R94.31","H10.45","H10.413","H04.123","H16.143","I34.0","I51.7","Z03.818","H93.12","Z20.828","R53.81","J02.9","E78.2","C50.811","K51.919","E04.9","L82.1","Z71.9","Z20.822","I16.0","M54.41","K51.80","D12.7","K52.3","L90.5","H93.11","M26.603","R20.0","E66.9","R20.2","N39.0","R35.0","Z01.411","R10.2","R14.0","K51.011"],"date":["2021-01-20","2021-01-20","2021-01-20","2021-11-15","2021-06-22","2021-06-22","2022-09-12","2021-06-22","2022-09-12","2022-08-31","2022-06-09","2021-06-22","2021-06-22","2021-06-22","2022-06-08","2022-06-08","2022-06-08","2022-09-12","2022-09-12","2021-03-23","2021-11-15","2020-02-20","2020-04-13","2022-06-08","2020-04-14","2021-11-15","2021-03-02","2021-04-01","2021-04-01","2021-04-01","2021-06-03","2022-06-09","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2020-02-19","2020-02-19","2020-02-19","2020-03-06","2020-11-11","2021-06-03","2020-06-16","2020-12-14","2020-12-14","2020-06-16","2020-01-15","2020-04-10","2020-04-10","2020-12-14","2020-04-10","2021-04-01","2021-04-01","2021-04-23","2022-08-31","2021-01-26","2021-11-15","2022-08-12","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2021-06-28","2021-06-28","2021-07-26","2021-07-31","2022-01-11","2022-06-08","2022-06-08","2022-06-08","2020-02-18","2020-07-21","2020-07-21","2020-11-30","2020-11-30","2020-11-30","2021-09-17","2021-09-17","2021-09-28","2021-09-28","2021-09-28","2022-09-07"],"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":[["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","62559013807","HYDROCORT","ENE 100MG","1680","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","60","Select","Select",""],["","71269050010","SLO-NIACIN","TAB 500MG ER","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","65862076890","FENOFIBRATE","TAB 48MG","60","Select","Select",""],["","00456140230","BYSTOLIC","TAB 2.5MG","30","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","60505083305","AZELASTINE","SPR 0.001","30","Select","Select",""],["","33342017910","OLMESA","TAB 20MG","30","Select","Select",""],["","00093753656","ANASTROZOLE","TAB 1MG","30","Select","Select",""],["","31722088390","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","00093354143","ESTRADIOL","CRE 0.0001","42","Select","Select",""],["","16729003410","LETROZOLE","TAB 2.5MG","90","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","68382056501","METOPROL","TAB 50MG ER","30","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","24208062902","BEPREVE","DRO 0.015","5","Select","Select",""],["","24208035310","ALREX","SUS 0.002","10","Select","Select",""],["","00093768432","OLOPATADINE","SOL 0.002","5","Select","Select",""],["","60758088005","FLUOROMETHOL","SUS 0.1% OP","5","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","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":""}]}]}