{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ECIRTALNEDRAD D ","gend":1,"add":"AG 4701RD NEDR","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1977-09-02","age":"","mstatus":"","insh":"7018410*76","cliId":"","pno":"29\/7577757-7","cno":"483-1349","email":"","ename":"","eno":"","pphy":"BOLDEN, KELLE D MD","ppno":"757\/594-1850","pcpadd":"STE 140 11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Port Warwick","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":["Z20.828","J06.9","J39.9","F43.23","F41.9","F41.1","N76.0","R10.13","J01.81","B96.89","R06.2","U07.1","Z03.818","Z11.59","K21.9","K42.9","R05.","R09.81","Z20.822","F33.1","J40.","R05.9","R06.00","Z86.16","R50.9","R07.9","M25.561","Z23.","L73.2","L91.8","Z12.31","G89.29","S80.02XA","S60.222A","S80.212A","S49.92XA","F41.0","F32.1","L85.8","Z71.9","J02.0","Z00.00","E55.9","J02.9","J34.89","M79.675","Z13.220","Z13.0","Z13.1","B34.9","N89.8","F32.2","Z91.89","M54.5","M79.604","R94.31","Z01.810","F33.9","Z13.29","Z01.419","Z12.4","L01.00","Z11.1","N76.89"],"date":["2020-12-13","2020-12-16","2020-12-30","2021-12-30","2021-02-24","2021-07-19","2020-11-25","2020-09-02","2020-09-02","2020-09-02","2020-12-16","2020-12-16","2020-08-12","2020-08-12","2020-09-02","2020-09-02","2020-12-28","2021-04-02","2021-12-26","2021-07-19","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2020-01-27","2020-03-30","2021-10-21","2021-10-21","2021-12-10","2021-12-10","2021-10-21","2021-10-21","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-06-07","2021-06-07","2021-12-10","2021-12-10","2020-09-16","2021-04-05","2021-04-05","2021-12-26","2021-12-26","2019-11-04","2021-04-02","2021-04-02","2021-04-02","2021-12-19","2019-06-06","2019-10-07","2019-02-28","2019-11-19","2019-12-16","2019-01-09","2019-01-09","2021-05-06","2019-10-07","2019-03-28","2019-03-28","2019-03-28","2019-03-28","2019-11-02"],"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":[["","64764017530","DEXILANT","CAP 60MG DR","60","Select","Select",""],["","00781707787","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","53191036201","VITAMIN","CAP 50000UNT","16","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","30","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","28","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","15","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","69315090405","LORAZEPAM","TAB 0.5MG","20","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","15","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00234057504","HIBICLENS","LIQ 0.04","118","Select","Select",""],["","51672130100","AMMONIUM","CRE 0.12","385","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":""}]}]}