{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" G   AINOTINIDRANREB","gend":1,"add":"ILC 37RD EN","city":"HAMPTON","state":"VA","zip":"23666-9998","dob":"1958-04-13","age":"","mstatus":"","insh":"83200210*55","cliId":"","pno":"-6284776","cno":"","email":"","ename":"","eno":"","pphy":"SALAZAR, JUAN S MD","ppno":"757\/827-2025","pcpadd":"4001 COLISEUM DR STE 300","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - CarePlex West","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M51.36","G80.8","M25.551","M21.069","M53.3","I10.","M25.552","L60.3","M77.52","M77.51","M79.672","M79.671","B35.1","F32.5","E89.0","Z12.11","Z23.","Z11.59","Z12.39","F17.210","R87.610","R87.810","Z79.899","D07.1","E03.9","Z00.00","F32.9","Z01.810","Z01.812","G80.9","J45.909","N39.3","Z91.81","Z88.0","Z88.5","Z79.890","Z79.1"],"date":["2022-11-15","2022-05-31","2022-05-31","2022-02-23","2022-11-15","2022-11-15","2022-05-31","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2021-05-07","2022-11-15","2022-11-15","2020-12-10","2020-12-10","2020-12-10","2020-06-23","2022-11-15","2022-05-31","2022-05-31","2022-11-15","2022-11-15","2022-06-07","2022-02-23","2021-08-19","2022-11-07","2022-11-07","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2022-11-15","2022-11-15"],"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":[["","55111018015","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","68382025601","OXYBUTYNIN","TAB 10MG ER","30","Select","Select",""],["","59310057922","PROAIR","AER ","26","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","60","Select","Select",""],["","68382009705","PAROXETINE","TAB 10MG","90","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","26","Select","Select",""],["","69238183107","LEVOTHYROXIN","TAB 50MCG","30","Select","Select",""],["","51672138602","FLUOCINONIDE","CRE 0.0005","30","Select","Select",""],["","59746036290","VALSARTAN","TAB 160MG","90","Select","Select",""],["","00536126456","CAPSAICIN","CRE 0.001","42","Select","Select",""],["","00378427577","VALACYCLOVIR","TAB 500MG","10","Select","Select",""],["","59762013100","SILVER","CRE 0.01","20","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","00904699880","DOCUSATE","CAP 100MG","30","Select","Select",""],["","68462020013","TELMISARTAN","TAB 40MG","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":""}]}]}