{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NIDLAREGNOTSLA E","gend":1,"add":"AC0182EVA R","city":"NORFOLK","state":"VA","zip":23504,"dob":"1983-01-22","age":"","mstatus":"","insh":"7333210*85","cliId":"","pno":"97\/7578897-0","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/446-5955","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent 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":["O24.313","O10.013","O34.219","O99.210","E66.01","I48.0","E11.65","I10.","E11.9","D64.9","R30.0","B37.3","O36.5920","O10.912","O24.112","Z3A.23","O9A.219","Z3A.33","T14.90XA","O35.8XX0","V23.82","O24.113","Z3A.36","Z37.0","O34.211","Z86.39","Z23.","F41.9","NO DATA","Z30.017","O99.891","M54.9","Z3A.22","O16.9","R73.9","Z3A.35","G89.18","Z3A.27","O10.92","O99.42","O24.12","I48.91","Z79.4","Z79.899","O99.214","O99.284","O99.824","Z20.822","E55.9","N92.1","Z97.5","Z30.9","Z30.46","Z30.42","Z32.02","V23.9","O10.919","O24.319","Z3A.08","R82.90","Z3A.11","M25.561","M17.11","O99.411","I11.9","O99.281","O9A.212","S39.81XA","O99.412","O09.522","Z79.82","Z88.8","Z3A.20","Z71.3","Z3A.24","O35.BXX0","Z3A.28"],"date":["2021-03-23","2021-04-15","2021-04-13","2021-03-23","2021-04-13","2022-10-21","2022-08-15","2022-08-15","2021-09-23","2021-07-19","2021-07-19","2021-09-23","2021-02-12","2022-09-29","2022-11-17","2021-01-15","2022-09-29","2021-03-25","2021-03-25","2021-03-05","2021-03-05","2021-04-15","2021-04-15","2021-04-15","2022-09-29","2022-05-05","2022-11-17","2021-11-23","2021-11-23","2021-04-17","2021-01-07","2021-01-07","2021-01-07","2021-04-06","2021-04-06","2021-04-06","2021-04-16","2022-11-17","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2022-09-29","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-04-13","2021-06-29","2021-06-29","2021-06-07","2021-06-29","2021-10-13","2021-10-13","2022-11-17","2022-11-17","2022-11-21","2022-07-07","2022-10-27","2022-08-15","2022-01-04","2022-01-04","2022-08-15","2022-08-15","2022-08-15","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2022-10-27","2022-10-27","2022-11-21","2022-11-21"],"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":[["","67877019805","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","","RA","TAB 81MG EC","","Select","Select",""],["","","LABETALOL","TAB 300MG","","Select","Select",""],["","","LEVEMIR","INJ FLEXTOUC","","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","","FEROSUL","TAB 325MG","","Select","Select",""],["","51672200306","CLOTRIMAZOLE","CRE 1% VAG","45","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","30","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","00536123441","ASPIRIN","TAB 81MG EC","60","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","70010006505","METFORMIN","TAB 1000MG","180","Select","Select",""],["","00904759161","FERROUS","TAB 325MG","60","Select","Select",""],["","68180063709","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","00168034646","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","00536406301","CL","TAB 28-0.8MG","30","Select","Select",""],["","39328010610","PRENATAL","TAB 27-1MG","30","Select","Select",""],["","13925011701","SE-NATAL","CHW ","30","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","","FOLIC","TAB 1000MCG","","Select","Select",""],["","","VITAMIN","CAP 50MCG","","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","200","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","73070010315","INSULIN","INJ FLEXPEN","30","Select","Select",""],["","16714002610","ENOXAPARIN","INJ 60\/0.6ML","5","Select","Select",""],["","00193709021","CONTOUR","TES BLD GLUC","100","Select","Select",""],["","51672203506","MICONAZOLE","CRE 0.02","45","Select","Select",""],["","","ONE","MIS PRENATAL","","Select","Select",""],["","","DILT-XR","CAP 180MG","","Select","Select",""],["","63736044201","MONISTAT","CRE 0.04","15","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","3","Select","Select",""],["","00548585000","GLUCAGON","KIT 1MG","1","Select","Select",""],["","65162003310","APAP\/CODEINE","TAB 300-30MG","10","Select","Select",""],["","63304071990","DILTIAZEM","CAP 180MG ER","30","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","25","Select","Select",""],["","80681013800","CALCIUM\/D3","TAB 600MG","60","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00904675060","DOK","TAB 100MG","30","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","100","Select","Select",""],["","21292000618","TRUE","TES GLUCOSE","100","Select","Select",""],["","16714036004","MONO-LINYAH","TAB 0.25-35","28","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","13668000901","CITALOPRAM","TAB 10MG","60","Select","Select",""],["","","D3","CAP 50MCG","","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":""}]}]}