{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ICARTELKNIW","gend":1,"add":"ELG EHT 0003171 TPA NL EB","city":"CHARLES CITY","state":"VA","zip":"23030-9998","dob":"1987-08-12","age":"","mstatus":"","insh":"6583110*71","cliId":"","pno":"32\/4084332-8","cno":"","email":"","ename":"","eno":"","pphy":"SINGH, GURWINDER MD","ppno":"703\/523-1720","pcpadd":"2280 OPITZ BLVD STE 250","pcpcity":"WOODBRIDGE","pcpstate":"VA","pcpzip":22191,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - New Town","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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":["F11.20","F14.90","F41.9","F33.1","K02.9","K04.7","F17.210","Z98.890","K08.89","G89.29","F19.90","R11.2","K21.9","F32.9","F34.1","Z76.0","R42.","S83.91XA","X50.1XXA","K29.60","F33.41","F17.200","G56.91","Q76.49","M21.611","M21.612","Z00.00","Z76.89","J18.9","F33.9"],"date":["2021-07-28","2020-07-01","2020-07-29","2020-07-29","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2021-05-17","2020-02-16","2021-04-18","2021-04-18","2021-04-18","2019-05-02","2019-02-21","2019-05-16","2019-04-29","2019-10-09","2019-10-09","2019-01-16","2019-01-16","2019-05-28","2019-01-16","2019-05-28","2019-01-16","2019-01-16","2019-05-28","2019-05-28","2019-05-28","2019-05-28"],"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":[["","12496120803","SUBOXONE","MIS 8-2MG","28","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","8","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","57237004105","PENICILLN","TAB 500MG","40","Select","Select",""],["","65162046450","IBUPROFEN","TAB 400MG","90","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","","LUCEMYRA","TAB 0.18MG","","Select","Select",""],["","","CLONIDINE","TAB 0.1MG","","Select","Select",""],["","55111015901","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00054060313","DESVENLAFAX","TAB 25MG ER","30","Select","Select",""],["","00591551305","CARISOPRODOL","TAB 350MG","60","Select","Select",""],["","59746028390","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","64980032005","TRIAMCINOLON","PST DEN 0.1%","5","Select","Select",""],["","55111068405","IBU","TAB 800MG","90","Select","Select",""],["","11822013729","RA","CAP 100MG","60","Select","Select",""],["","11822315230","LORATADINE","TAB 10MG","30","Select","Select",""],["","00781577626","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","65862001230","SERTRALINE","TAB 50MG","30","Select","Select",""],["","13668001101","CITALOPRAM","TAB 40MG","30","Select","Select",""],["","37000045503","PRILOSEC","TAB 20MG","28","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","15","Select","Select",""],["","58160089652","FLUARIX","INJ 2019-20","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":""}]}]}