{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  AT-NAEKNOTROM M ","gend":0,"add":"OFDARB 5295B TPA RD DR","city":"SUFFOLK","state":"VA","zip":"23435-9998","dob":"1999-05-09","age":"","mstatus":"","insh":"58300210*47","cliId":"","pno":"14\/7575706-9","cno":"","email":"","ename":"","eno":"","pphy":"RAMOLIA, MANSUKHLAL R MD","ppno":"757\/483-6401","pcpadd":"4035 TAYLOR RD #K","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"","pcpname":"FIRST CARE PC","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.2","F51.01","F33.1","F43.10","J18.9","Z90.81","K21.9","Z72.0","NO DATA","Z00.00","A41.9","J85.1","J96.01","E87.2","J45.21","E88.09","F17.210","F31.9","F90.9","K59.09","Z79.51","Z79.899","Z87.01","Z87.828","J98.4","J18.1","R91.1","J45.909","J30.9","J32.9","J33.9","D72.828","K56.609","D72.829","Z98.890","R10.9","K59.00","Z20.828","R50.9","R91.8","J45.901","K56.2","R10.84","E87.6","D72.9","S39.012A","S80.02XA","Z71.9","I51.7","R00.0","J90.","K56.7","R05.","R68.83","R11.2","R59.0","Z20.822","Z82.5","Z90.49","F43.23","N34.2","V58.89","H53.8","F90.1","S01.112A"],"date":["2021-06-17","2020-05-13","2020-05-13","2020-05-13","2021-01-06","2021-06-02","2021-06-02","2021-03-03","2021-06-02","2020-06-01","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-12-09","2020-12-09","2020-12-09","2021-06-02","2021-06-02","2020-12-09","2020-12-09","2021-06-02","2020-12-09","2021-03-03","2021-03-03","2020-12-13","2020-12-13","2021-06-02","2021-04-26","2021-04-26","2021-04-26","2021-02-18","2021-06-17","2021-06-17","2021-06-17","2021-06-02","2020-01-10","2020-12-09","2020-12-09","2020-12-15","2020-12-13","2021-06-02","2021-06-02","2021-06-02","2021-06-02","2021-11-17","2021-11-17","2020-02-10","2021-05-13","2021-06-02","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-09","2020-12-14","2021-06-02","2021-06-02","2021-06-02","2019-06-13","2019-08-26","2019-04-18","2019-04-18","2019-07-24","2019-04-07"],"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":{"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":[["","71143037501","XHANCE","MIS 93MCG","16","Select","Select",""],["","00591292754","LEVALBUTEROL","AER 45\/ACT","30","Select","Select",""],["","","CULTURELLE","CAP HLTH\/WEL","","Select","Select",""],["","00527131530","RIFAMPIN","CAP 300MG","180","Select","Select",""],["","00555007102","ISONIAZID","TAB 300MG","180","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","8","Select","Select",""],["","61748001206","PYRAZINAMIDE","TAB 500MG","270","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00173071720","ADVAIR","AER 230\/21","12","Select","Select",""],["","69097084805","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00456120330","LINZESS","CAP 72MCG","30","Select","Select",""],["","10702001850","OXYCODONE","TAB 5MG","20","Select","Select",""],["","","PREDNISONE","TAB 10MG","","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","60505004101","ETODOLAC","TAB 400MG","20","Select","Select",""],["","54879000201","ETHAMBUTOL","TAB 400MG","270","Select","Select",""],["","00781751787","BUDESONIDE","SUS 1MG\/2ML","180","Select","Select",""],["","42806004801","GUANFACINE","TAB 1MG","180","Select","Select",""],["","76385012350","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","00378345823","AZEL\/FLUTIC","SPR 137-50","23","Select","Select",""],["","00186199004","PULMICORT","SUS 1MG\/2ML","60","Select","Select",""],["","43547034050","RISPERIDONE","TAB 0.5MG","30","Select","Select",""],["","00456241060","SAPHRIS","SUB 10MG","30","Select","Select",""],["","","VIOS","MIS SYSTEM","","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","59417010310","VYVANSE","CAP 30MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","","SINUVA","IMP 1350MCG","","Select","Select",""],["","","DEBROX","SOL 6.5% OT","","Select","Select",""],["","00597008717","ATROVENT","AER 17MCG","13","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","00527458137","METHYLPHENID","CAP 30MG","30","Select","Select",""],["","67877025001","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN OP","14","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":""}]}]}