{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AYNOTSIWEL","gend":1,"add":"NAVLYSNNEP 42261 TPA EVA AI","city":"HAMPTON","state":"VA","zip":"23661-9998","dob":"1964-09-14","age":"","mstatus":"","insh":"78300210*19","cliId":"","pno":"88\/7579130-8","cno":"","email":"","ename":"","eno":"","pphy":"BROOKS, BONNIE J MD","ppno":"757\/594-1803","pcpadd":"SUITE 140 1183 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606","pcpcounty":"","pcpid":"","pcpname":"SENTARA MEDICAL GROUP","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":["I69.354","C50.912","I97.2","I10.","G62.9","T45.1X5A","F17.210","Z79.82","Z90.12","Z86.14","I63.9","G62.0","I89.0","E78.2","E55.9","F17.200","M19.011","L30.9","C79.51","R60.9","R27.8","M62.81","R47.81","C50.112","Z95.818","Z00.00","G89.4","J32.4","G47.9","Z01.419","N95.9","Z51.11","Z51.12","J32.2","J32.0","R09.81","J34.2","J33.9","J30.1","J30.89","R47.1","G81.94","G31.84","R41.4","Z17.0","Z72.0","Z85.3","Z79.899","Z95.828","Z80.3","Z12.39","J01.00","J34.89","Z23.","M19.012","K57.30","D25.9","K76.9","G81.02","I69.398","R53.1","J34.3","R06.83","E61.1","R55.","C50.919","R91.1","E87.6","R77.8","R07.89","Z86.73","M25.511","G81.90","R22.0","J33.0","E66.3","J30.2","I47.1","M62.838","R11.2","R19.7","R63.0","R00.0","M79.605","K08.89","I21.4","E83.42","J01.40","Z01.810","R94.31","R41.82","L70.0","L73.0","L81.0","Z71.9","I49.1"],"date":["2020-11-03","2021-10-01","2020-11-03","2021-11-29","2020-02-12","2021-09-30","2021-10-26","2020-07-21","2021-12-16","2020-02-12","2021-10-31","2021-09-30","2021-12-16","2021-11-29","2021-11-09","2021-11-09","2021-09-30","2021-09-24","2021-12-09","2020-02-13","2020-11-03","2020-06-04","2020-06-04","2021-12-09","2021-12-30","2021-01-11","2021-01-11","2021-09-30","2021-03-04","2021-01-11","2021-01-11","2021-12-09","2021-05-27","2021-07-19","2021-12-27","2021-12-27","2021-04-12","2021-04-28","2021-09-13","2021-12-27","2020-01-09","2020-01-09","2020-01-09","2020-01-09","2021-12-09","2020-05-26","2021-12-16","2021-12-16","2020-11-24","2020-11-24","2020-11-24","2021-02-15","2021-03-08","2021-09-30","2021-09-30","2021-10-05","2021-10-05","2021-10-05","2020-01-14","2020-06-02","2020-06-02","2021-03-08","2021-01-22","2021-11-09","2021-11-29","2021-10-03","2021-10-03","2021-10-03","2021-10-03","2021-11-18","2021-10-26","2020-01-08","2020-01-27","2021-07-19","2021-07-19","2021-07-19","2021-09-24","2021-11-29","2020-07-08","2021-10-01","2021-01-05","2021-01-05","2021-08-03","2020-07-21","2021-03-08","2021-10-02","2021-10-02","2020-09-03","2021-04-24","2021-10-02","2021-10-02","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-10-01"],"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":[["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00406052201","OXYCOD\/APAP","TAB 7.5-325","60","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","28","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","27","Select","Select",""],["","68180063702","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","75834002012","VITAMIN","CAP 50000UNT","6","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","12547017162","BENADRYL","CRE 1-0.1%","28","Select","Select",""],["","00378456105","POT  CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","60","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","16729003410","LETROZOLE","TAB 2.5MG","30","Select","Select",""],["","00713022515","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","11917007454","FERROUS","TAB 240MG","30","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","90","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","49483048110","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00363089688","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","08290305500","1ML","MIS 28GX1\/2\"","30","Select","Select",""],["","53191036201","D3-50","CAP 50000UNT","6","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","00363032908","WAL-DRYL","TAB 25MG","60","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","28","Select","Select",""],["","00591207030","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","00115168974","BUDESONIDE","SUS 0.5MG\/2","60","Select","Select",""],["","64980033912","MAGNESIUM-OX","TAB 400MG","30","Select","Select",""],["","00409120703","GENTAMICIN","INJ 40MG\/ML","2","Select","Select",""],["","00641614525","DEXAMETH","INJ 4MG\/ML","30","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":""}]}]}