{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" KCIRDEKTTERRAJ","gend":0,"add":"HCIR 513RD DNOM","city":"HAMPTON","state":"VA","zip":"23664-9998","dob":"1963-06-27","age":"","mstatus":"","insh":"5940210*75","cliId":"","pno":"37\/6461445-4","cno":"646\/734-5441","email":"","ename":"","eno":"","pphy":"EMECHEBE, NONSO S MD","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","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":["Z23.","Z21.","Z79.899","Z86.19","A63.0","B20.","Z72.0","F17.210","F17.290","K62.89","Z48.89","K62.9","R06.02","R11.10","R00.0","S91.342A","S20.361A","L08.9","A41.9","R10.31","R74.01","A41.51","K37.","R94.5","M79.89","D64.9","K92.1","Z20.828","R19.4","K59.00","R63.4","F12.90","Z87.891","Z83.71","K52.9","R60.0","F17.209","D50.9","K60.3","NO DATA","R50.9","R93.3","R79.89","R50.81","Z20.822","K56.7","Z16.11","Z16.29","Z28.21","Z82.49"],"date":["2022-02-16","2021-09-09","2022-08-31","2022-08-31","2022-06-15","2022-08-31","2021-08-18","2022-08-13","2022-08-13","2022-03-28","2021-12-20","2021-12-20","2022-08-13","2022-08-12","2022-08-13","2022-08-24","2022-05-02","2022-05-02","2022-08-15","2022-08-14","2022-08-14","2022-08-17","2022-08-17","2022-08-15","2021-03-23","2021-07-21","2021-03-23","2021-04-12","2021-05-28","2021-05-28","2021-09-09","2021-04-21","2021-04-21","2022-08-13","2022-08-14","2021-05-05","2021-09-09","2021-09-09","2022-06-15","2022-08-14","2022-08-14","2022-08-14","2022-08-12","2022-08-12","2022-08-13","2022-08-13","2022-08-13","2022-08-13","2022-08-13","2022-08-13"],"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":[]},{"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":[["","61958250101","BIKTARVY","TAB ","30","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","70000041502","CLEARLAX","POW ","238","Select","Select",""],["","23155065201","METRONIDAZOL","TAB 500MG","20","Select","Select",""],["","00143992950","CIPROFLOXACN","TAB 750MG","20","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","20","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","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":""}]}]}