{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ARUALLLIGCM","gend":1,"add":"EH EPAC S 0292202 MR EVA YRN","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1983-09-01","age":"","mstatus":"","insh":"9349710*45","cliId":"","pno":"35\/7574851-3","cno":"","email":"","ename":"","eno":"","pphy":"MACK, ALEXANDRA S MD","ppno":"757\/446-5955","pcpadd":"825 FAIRFAX AVE SUITE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23507,"pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z95.828","Z98.890","I72.3","Z86.79","R06.02","F43.22","K04.7","R22.0","K03.81","I11.0","I50.9","NO DATA","Z86.16","Z87.891","I10.","Z86.001","Z20.828","N18.3","F17.210","Z88.5","Z88.0","Z88.8","S91.311A","L08.9","L60.0","M79.674","M79.675","L60.3","R07.9","R10.32","B34.9","I11.9","I16.0","I50.22","Z68.41","I43.","Z79.899","F14.10","E66.01","M94.0","Z91.14","L30.9"],"date":["2021-01-19","2021-10-21","2021-01-19","2021-10-21","2021-08-24","2020-09-30","2020-10-27","2020-10-27","2020-10-27","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-08-24","2021-10-21","2021-10-21","2021-08-18","2020-04-27","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-06-09","2021-06-09","2020-03-18","2020-03-04","2020-03-04","2020-03-04","2019-01-31","2019-05-11","2019-01-23","2019-01-27","2019-01-28","2019-01-28","2019-01-28","2019-01-28","2019-01-28","2019-01-28","2019-01-28","2019-01-28","2019-01-28","2019-04-09"],"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":[["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","68382012305","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","64980030310","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","","DOK","CAP 100MG","","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","68382009405","CARVEDILOL","TAB 12.5MG","60","Select","Select",""],["","","PENLAC","SOL 0.08","","Select","Select",""],["","","STOOL","CAP 100MG","","Select","Select",""],["","","CICLOPIROX","SOL 0.08","","Select","Select",""],["","49348098115","SM","TAB 81MG EC","30","Select","Select",""],["","57664047758","METOPROL","TAB 50MG","60","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","28","Select","Select",""],["","00378214605","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","61442012110","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","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":""}]}]}