{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YHTAKNITRAM L","gend":1,"add":"LNOOM 3818DAOR THGI","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"1972-03-19","age":"","mstatus":"","insh":"8798810*80","cliId":"","pno":"73\/7572384-1","cno":"","email":"","ename":"","eno":"","pphy":"SMITH, EDDIE L MD","ppno":"757\/238-8751","pcpadd":"130609 CARROLLTON BLVD STE 11","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":23314,"pcpcounty":"","pcpid":"","pcpname":"EAGLE HARBOR MEDICAL ASSOCIATES","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":["F34.1","R11.2","R10.9","R14.0","Z48.815","K92.1","K63.89","K62.89","M65.352","M65.342","M65.332","Z68.20","K13.79","R11.10","F17.200","N83.209","R10.2","E53.8","Z98.84","J40.","D50.9","E55.9","R53.83","R53.81","K59.00","M54.5","K52.9","F31.63","F90.0","F41.1","F51.01","K55.9","F17.210","R60.0","D50.8","D72.819","E53.1","Z20.828","J02.9","M25.571","R06.2","Z01.818","G89.29","F90.9","F41.9","G89.4","G62.9","K04.7","G43.C0","R20.8","M79.2","K52.831"],"date":["2020-11-10","2021-02-12","2021-10-26","2021-10-26","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2021-02-12","2021-01-18","2021-02-12","2021-03-22","2021-03-22","2021-10-26","2021-10-26","2021-01-27","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-04-12","2021-03-11","2021-10-26","2021-11-08","2021-11-08","2021-11-08","2021-11-08","2021-02-12","2021-04-12","2021-06-25","2021-10-26","2021-10-26","2021-10-26","2020-09-19","2020-05-29","2020-10-27","2021-02-16","2019-03-22","2019-03-22","2019-03-22","2019-03-22","2019-03-22","2019-03-22","2019-01-25","2019-01-25","2019-03-13","2019-03-13","2019-01-18"],"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":[["","","AMITRIPTYLIN"," AMITRIPTYLIN ","60","Select","Select",""],["","","LAMOTRIGINE"," LAMOTRIGINE ","60","Select","Select",""],["","","AMPHET\/DEXTR"," AMPHET\/DEXTR ","60","Select","Select",""],["","50428847260","CVS","TAB 180MG","30","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","8","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","RIZATRIPTAN"," RIZATRIPTAN ","10","Select","Select",""],["","45802009851","MESALAMINE","ENE 4GM","1260","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","3","Select","Select",""],["","","RISPERIDONE","TAB 0.5MG","","Select","Select",""],["","50383004004","PRED","SOL 5MG\/5ML","200","Select","Select",""],["","68180015301","DESLORATADIN","TAB 5MG","90","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","","GABAPENTIN"," GABAPENTIN ","150","Select","Select",""],["","00456120230","LINZESS","CAP 290MCG","30","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","5676","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","","CLONIDINE"," CLONIDINE ","90","Select","Select",""],["","","WIXELA"," WIXELA ","60","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","","ADVAIR"," ADVAIR ","60","Select","Select",""],["","68180016006","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","52268070001","GOLYTELY","SOL ","1","Select","Select",""],["","67877057505","BENZONATATE","CAP 200MG","24","Select","Select",""],["","45963043864","ENULOSE","SOL 10GM\/15","5400","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","","BUDESONIDE","CAP 3MG DR","","Select","Select",""],["","","FLOVENT","AER 110MCG","","Select","Select",""],["","","AFLURIA","INJ 2020-21","","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":""}]}]}