{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LLERREDPASLIM ","gend":0,"add":"ELMUHC 239A TPA DR Y","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1980-12-01","age":"","mstatus":"","insh":"6671210*21","cliId":"","pno":"59\/7571507-6","cno":"757\/956-7051","email":"","ename":"","eno":"","pphy":"FEDRO, RANDALL C MD","ppno":"757\/686-3516","pcpadd":"3235 BRIDGE RD STE 15","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":"","pcpname":"North Suffolk Family Medicine","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":["B02.9","B20.","F17.200","Z79.899","R21.","B02.8","R22.2","Z21.","Z87.898","Z11.3","Z00.00","Z13.220","Z11.59","K08.89","B02.29","L29.9","L21.9","B35.1","R39.198"],"date":["2021-08-12","2021-11-22","2021-08-30","2021-11-22","2021-08-12","2021-08-30","2021-08-30","2021-08-30","2020-06-01","2021-09-15","2021-05-21","2021-05-21","2021-05-21","2021-06-02","2021-11-22","2020-07-25","2021-05-21","2021-11-22","2021-11-22"],"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",""],["","65862042001","SMZ\/TMP","TAB 800-160","30","Select","Select",""],["","63646001004","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","32","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","57237004330","VALACYCLOVIR","TAB 1GM","30","Select","Select",""],["","42858010250","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","90","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","69097073102","TERBINAFINE","TAB 250MG","42","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","15","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":""}]}]}