{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C M   ASILNEDNETTIR","gend":1,"add":"ITYM 18RD ENEL","city":"NEWPORT NEWS","state":"VA","zip":"23605-9998","dob":"1968-05-27","age":"","mstatus":"","insh":"95200210*07","cliId":"","pno":"22\/7577423-4","cno":"","email":"","ename":"","eno":"","pphy":"ORCIGA, LEE S NP","ppno":"757\/395-1900","pcpadd":"5460 WESLEYAN DR","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":"","pcpname":"SMG - TeleHealth Team","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":["F41.1","F32.1","L30.9","E11.9","Z79.84","M54.16","F41.9","K62.5","I80.8","I82.611","E11.65","I10.","M54.41","M47.816","M51.36","M54.42","G89.29","M43.16","K64.4","K02.9","E11.59","K92.2","K64.9","K58.9","Z79.4","Z71.9","I82.401","L02.01","M54.5","M25.551","M41.9","R82.71","R19.7","L20.9","R06.2","Z72.0","K92.1"],"date":["2021-12-15","2021-12-15","2021-08-26","2020-10-06","2021-03-31","2021-03-23","2020-01-09","2021-05-18","2019-01-04","2019-01-04","2021-03-31","2021-03-31","2021-05-20","2021-05-20","2021-05-20","2020-04-21","2021-05-20","2021-05-20","2021-05-18","2021-09-14","2021-03-31","2020-11-29","2020-11-29","2020-11-29","2021-03-31","2021-08-26","2019-01-04","2019-06-26","2019-09-19","2019-09-19","2019-09-19","2019-09-19","2021-05-18","2020-08-26","2020-08-26","2020-08-26","2020-08-26"],"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":[["","","ALPRAZOLAM"," ALPRAZOLAM ","60","Select","Select",""],["","","LANTUS","INJ 100\/ML","","Select","Select",""],["","","ESCITALOPRAM"," ESCITALOPRAM ","30","Select","Select",""],["","","BD  PEN NEEDL","MIS 32GX5\/32","","Select","Select",""],["","","GLIMEPIRIDE"," GLIMEPIRIDE ","60","Select","Select",""],["","","BUSPIRONE"," BUSPIRONE ","60","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","METFORMIN"," METFORMIN ","30","Select","Select",""],["","","TRIAMCINOLON"," TRIAMCINOLON ","30","Select","Select",""],["","","TRAZODONE"," TRAZODONE ","30","Select","Select",""],["","00310654004","BYDUREON","INJ 2\/0.85ML","3","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","","HYDROXYZ","TAB 10MG","","Select","Select",""],["","","ONETOUCH"," ONETOUCH ","50","Select","Select",""],["","68462060994","PIMECROLIMUS","CRE 0.01","100","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00713032637","BETAMETH","CRE 0.001","45","Select","Select",""],["","42494030124","HYDROCORT","SUP 25MG","24","Select","Select",""],["","","LIDOCAINE"," LIDOCAINE ","100","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","","TIZANIDINE","TAB 4MG","","Select","Select",""],["","","BASAGLAR","INJ 100UNIT","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}