{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ECIRTALSIVAD L ","gend":1,"add":"IFFUR 7022G TPA DR N","city":"RICHMOND","state":"VA","zip":"23234-9998","dob":"1991-09-17","age":"","mstatus":"","insh":"7789110*14","cliId":"","pno":"25\/3020329-3","cno":"203\/923-6299","email":"","ename":"","eno":"","pphy":"YU, TIMOTHY MD","ppno":"804\/739-6142","pcpadd":"13540 HULL STREET ROAD","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":23112,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS ST. FRANCIS FAMILY MEDICINE CENTER","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K21.9","K59.00","E86.0","R11.2","R19.7","R10.13","R19.4","K50.90","B96.81","M54.9","J45.909","M94.0","R52.","NO DATA","Z68.41","M54.5","M54.6","Z11.52","K29.50","K51.90","Z65.9","R11.0","R21.","L29.9","Z34.93","Z3A.37","O99.824","D64.9","O69.81X0","Z37.0","O99.02","O70.0","R30.0","R10.2","Z71.89","L25.9","Z68.42","O99.345","N89.8","Z20.2"],"date":["2021-04-09","2021-02-17","2020-01-14","2020-01-14","2020-01-14","2021-04-16","2021-04-16","2021-12-21","2021-08-17","2020-07-25","2020-07-25","2020-12-19","2021-12-13","2020-08-05","2020-08-05","2020-07-25","2020-07-25","2021-04-09","2021-06-29","2021-06-29","2021-04-14","2021-10-26","2019-07-18","2019-07-18","2019-01-06","2019-01-08","2019-01-08","2019-01-08","2019-01-08","2019-01-08","2019-01-08","2019-01-08","2019-06-10","2019-06-10","2019-03-20","2019-01-18","2019-01-25","2019-02-06","2019-12-29","2019-12-29"],"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":[["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","68382071119","MESALAMINE","TAB 1.2GM","60","Select","Select",""],["","52268020101","SUTAB","TAB ","24","Select","Select",""],["","43199001101","HYOSCYAMINE","SUB 0.125MG","60","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","65162077810","BUDESONIDE","CAP 3MG DR","90","Select","Select",""],["","00527193206","CLARITHROMYC","TAB 500MG","20","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","40","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","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":""}]}]}