{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EL NHOJII NORB","gend":0,"add":"NITTON 018DAOR MAHG","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1977-10-20","age":"","mstatus":"","insh":"70400210*56","cliId":"","pno":"84\/7579567-8","cno":"","email":"","ename":"","eno":"","pphy":"OHANIAN, KARO G MD","ppno":"757\/397-6344","pcpadd":"3640 HIGH STREET SUITE 3B","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23707,"pcpcounty":"","pcpid":"","pcpname":"EVMS Portsmouth Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["I10.","Z68.35","G25.81","E78.00","F31.32","G47.33","R53.83","F31.9","Z68.36","F31.5","F42.2","F40.10","F12.21","Z79.899","R21.","Z23.","F33.2","R07.9","R06.02","Z87.09","F31.81","F17.200","F10.10","Z86.79","I45.6","R07.89","E66.9","F31.30","K62.5","K64.8","Z12.11","E66.3","F17.290","K92.1","K63.5"],"date":["2022-01-19","2020-01-17","2020-12-07","2022-01-19","2020-01-03","2021-05-19","2020-01-21","2022-01-19","2020-01-21","2022-07-05","2022-07-05","2022-07-05","2022-04-11","2021-10-14","2021-10-14","2021-10-14","2020-01-10","2019-08-05","2019-04-24","2019-04-01","2019-06-21","2019-08-30","2019-07-30","2019-06-13","2019-07-17","2019-06-13","2019-10-23","2019-03-12","2022-06-06","2022-06-06","2022-11-04","2022-06-06","2022-06-06","2022-05-20","2022-11-04"],"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":[["","43598048672","NICOTINE","LOZ 2MG MINT","72","Select","Select",""],["","63402031230","LATUDA","TAB 120MG","30","Select","Select",""],["","68382080601","TRAZODONE","TAB 100MG","30","Select","Select",""],["","65862059501","DIVALPROEX","TAB 500MG ER","180","Select","Select",""],["","69097087502","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","43547035003","PAROXETINE","TAB 40MG","45","Select","Select",""],["","67877019705","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","4","Select","Select",""],["","60505257809","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","11822323910","RA","LOZ 2MG MINT","30","Select","Select",""],["","00713050324","ANUCORT-HC","SUP 25MG","3","Select","Select",""],["","68462029855","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","65162024709","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","68462033090","PRAMIPEXOLE","TAB 0.125MG","90","Select","Select",""],["","","FLUARIX","INJ 2020-21","","Select","Select",""],["","00085113201","PROVENTIL","AER HFA","7","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":""}]}]}