{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" R   HAELNOSAMOHT","gend":1,"add":"AS 6564TC YOV","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1997-10-01","age":"","mstatus":"","insh":"79300210*44","cliId":"","pno":"36\/7574950-1","cno":"","email":"","ename":"","eno":"","pphy":"GRAHAM, MARY O MD","ppno":"757\/460-1207","pcpadd":"1147 INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICAL PRACTITIONERS","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.62","V62.84","F10.20","J30.2","Z91.5","Z87.891","F33.2","F31.81","F41.1","Z30.41","F43.22","F31.9","R79.89","Z01.419","R10.32","N93.8","R53.83","Z30.49","F33.1","F12.20","N71.9","N93.0","G47.00","J45.909","M54.5","K21.9","I10.","R31.1","E55.9","T43.592A","T42.4X2A","T43.212A","F32.9","Z79.899","R40.0","F19.10","Z72.821","G47.429","G47.33","R06.83","G47.8","Z91.89","Z82.0","R11.2","G89.29","E78.2","E83.111","Z01.411","L70.9","L02.33","M25.539","R74.8","Z87.81","N64.4","L29.9","K76.9","Z71.3"],"date":["2020-09-29","2020-09-29","2021-03-15","2020-09-30","2020-09-29","2021-07-29","2020-10-04","2021-08-11","2021-08-11","2021-05-27","2021-08-02","2021-09-27","2021-03-17","2020-09-18","2021-12-15","2020-09-29","2021-09-27","2020-09-29","2021-03-15","2021-03-15","2021-12-15","2021-11-10","2021-09-27","2020-08-18","2021-08-08","2021-07-05","2021-07-29","2021-07-05","2021-02-01","2021-03-15","2021-03-15","2021-03-15","2021-03-15","2021-06-29","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-08-08","2021-08-08","2021-01-29","2021-03-01","2021-12-15","2021-12-15","2021-12-15","2020-09-30","2021-03-17","2020-09-30","2020-10-01","2020-10-01","2021-03-17","2021-03-17"],"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":[["","00054252625","LITHIUM","CAP 150MG","90","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","30","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","90","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","10","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","90","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","68462072029","DROSPIRENONE","TAB ETHY EST","56","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","15","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","414","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","90","Select","Select",""],["","00555902658","JUNEL","TAB 43831","84","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","20","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","30","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","14","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":""}]}]}