{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YELRAHNNUD N ","gend":1,"add":"YLC 66NL SED","city":"WINDSOR","state":"VA","zip":"23487-9998","dob":"1994-10-08","age":"","mstatus":"","insh":"6220410*35","cliId":"","pno":"56\/7570606-3","cno":"","email":"","ename":"","eno":"","pphy":"WEITZMAN, DOUGLAS K MD","ppno":"757\/542-2000","pcpadd":"STE 200 20209 SENTARA WAY","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":23314,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - St. Luke's","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T78.40XA","G56.02","R10.9","K92.1","N75.0","K92.0","NO DATA","M25.569","F98.8","F41.9","G47.00","V58.89","S70.11XA","N30.00","F43.23","T40.2X1A","R11.0","R51.9","R07.89","F17.200","Z20.822","T50.901A","Z51.89","Z48.02","F11.20","M25.531","E16.1","O24.414","E78.2","E28.2","Z72.0","M54.5","K76.9","G89.29","G56.01","S70.12XA","R25.2","H60.502","B37.3","G56.03"],"date":["2021-07-01","2021-07-01","2020-03-05","2020-03-05","2020-03-05","2020-12-02","2020-12-02","2021-05-05","2021-05-05","2021-05-05","2021-05-05","2021-05-20","2021-03-08","2021-03-08","2021-01-14","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2021-12-16","2020-09-24","2020-09-24","2021-06-15","2019-11-04","2019-08-19","2019-08-19","2019-08-19","2019-08-19","2019-08-19","2019-08-19","2019-08-19","2019-08-19","2019-11-12","2019-05-16","2019-05-16","2019-08-07","2019-08-07","2019-11-07"],"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":[["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","","ZOLPIDEM","TAB 10MG","","Select","Select",""],["","00555097402","AMPHET\/DEXTR","TAB 30MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","14","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","67877025001","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","20","Select","Select",""],["","57844013001","ADDERALL","TAB 30MG","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","29300012410","MELOXICAM","TAB 7.5MG","15","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","16729013716","CLONAZEPAM","TAB 1MG","6","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","15","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","28","Select","Select",""],["","","VENLAFAXINE","CAP 37.5 ER","","Select","Select",""],["","00591551305","CARISOPRODOL","TAB 350MG","30","Select","Select",""],["","63481042105","COLY-MYCIN","SUS OTIC","10","Select","Select",""],["","62175047132","PAROXETINE","TAB 25MG ER","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","26","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","62175047032","PAROXETIN","TAB 12.5MG","30","Select","Select",""],["","61314064511","NEO\/POLY\/HC","SUS 1% OTIC","10","Select","Select",""],["","31722054201","INDOMETHACIN","CAP 25MG","30","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","30","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":""}]}]}