{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"D   SEMAJRUMKEERC ","gend":0,"add":" YTNUOC 009722 TPA TS","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1967-08-08","age":"","mstatus":"","insh":"95200210*93","cliId":"","pno":"13\/7570391-8","cno":"","email":"","ename":"","eno":"","pphy":"FIELDS-SYKES, KAREN A NP","ppno":"757\/738-1225","pcpadd":"3537 AIRLINE BLVD STE 1","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23701,"pcpcounty":"","pcpid":"","pcpname":"AIRLINE BOULEVARD MEDICAL ASSOCIATES","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":["R06.02","R06.9","F10.10","F33.1","F14.10","Z23.","I10.","Z68.31","J44.9","E78.5","K50.00","R51.","M54.89","F41.8","F10.120","M19.90","E78.00","F17.210","Z79.899","T65.91XA","F11.20","F11.10","R40.20","R09.02","T40.1X1A","R41.82","T50.995A","F33.2","K50.10","R10.31","K52.9","R19.4","K21.9","K29.70","R11.2","F32.9","H33.321","H25.13","H40.053","J43.9","F17.200","Z68.26","R52.","M54.6","F41.9"],"date":["2021-06-02","2021-11-04","2021-09-14","2021-09-10","2021-09-28","2020-09-29","2021-11-04","2020-09-23","2021-11-04","2021-11-04","2020-09-29","2020-09-29","2021-08-23","2021-10-02","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-10-02","2021-10-02","2021-03-03","2021-03-03","2021-03-03","2021-03-03","2021-11-04","2019-04-15","2019-04-04","2019-02-02","2019-03-07","2019-03-07","2019-03-07","2019-02-02","2019-02-02","2019-12-12","2019-01-28","2019-01-28","2019-01-28","2019-02-18","2019-02-18","2019-02-18","2019-05-24","2019-05-24","2019-12-06"],"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":[["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","3","Select","Select",""],["","","AMLODIPINE","TAB 5MG","","Select","Select",""],["","68645048154","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","59310058020","PROAIR","AER ","1","Select","Select",""],["","","TOPIRAMATE","TAB 100MG","","Select","Select",""],["","16714035201","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","00527058601","DICYCLOMINE","CAP 10MG","20","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","68645055754","LISINOP\/HCTZ","TAB 20-12.5","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","12","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":""}]}]}