{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" EINREBLALLEWDUTS","gend":0,"add":"EW 2031EVA TS","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1962-12-08","age":"","mstatus":"","insh":"79300210*51","cliId":"","pno":"52\/7578896-6","cno":"","email":"","ename":"","eno":"","pphy":"GOSWAMI, BIJOYA MD","ppno":"757\/594-1803","pcpadd":"STE 140 11803 JEFFERSON AVE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Port Warwick","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":["I20.0","M10.9","I10.","I25.10","E78.2","Z12.5","E55.9","M1A.09X0","I21.21","R07.2","I21.29","I50.23","I13.0","F17.210","E11.22","N18.9","D64.9","F14.10","I95.9","E78.5","Z91.19","Z79.899","Z91.14","Z82.49","R07.9","I42.2","I51.89","I25.2","Z95.5","Z72.0","N52.9","F32.9","Z79.82","M25.431"],"date":["2020-10-03","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-16","2020-10-03","2020-10-03","2020-10-03","2020-10-03","2020-10-04","2020-10-05","2020-10-05","2021-08-31","2020-10-16","2020-10-16","2020-10-16","2019-10-25","2019-10-25","2019-10-25"],"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":[["","","METOPROL","TAB 50MG ER","","Select","Select",""],["","00591554310","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","00254200801","COLCHICINE","TAB 0.6MG","30","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","12","Select","Select",""],["","","AMLODIPINE","TAB 10MG","","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00603533932","PREDNISONE","TAB 20MG","18","Select","Select",""],["","","ATORVASTATIN","TAB 80MG","","Select","Select",""],["","","PRASUGREL","TAB 10MG","","Select","Select",""],["","","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","","SILDENAFIL","TAB 25MG","","Select","Select",""],["","64764011901","COLCRYS","TAB 0.6MG","30","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","18","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":""}]}]}