{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YRREHSNAELCM S","gend":1,"add":"LO E 439DAOR YEN","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1980-01-28","age":"","mstatus":"","insh":"9643410*55","cliId":"","pno":"26\/7574342-2","cno":"757\/622-2434","email":"","ename":"","eno":"","pphy":"GUNTHER, ALTHEA O 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":["F30.9","M77.41","B07.0","L85.3","M77.42","S00.81XA","R40.20","M54.9","S27.329A","V23.2XXA","R10.13","G89.29","M79.672","F12.90","R11.0","F17.210","F17.290","M43.6","L84.","R07.9","H04.123","H52.7","Z79.899","H53.8","F20.9","N92.0","F41.9","F32.9","H10.33","R00.0","E11.9","NO DATA","S27.322A","S06.9X9A","S40.212A","S80.01XA","R40.2412","Z79.84","F33.1","L98.9","Z83.3","D64.9","M25.471","M25.472","Z72.0","M25.512","J45.909","N93.9","R10.32"],"date":["2020-05-10","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-09-04","2022-09-04","2022-09-04","2022-09-04","2022-09-04","2021-10-07","2021-10-07","2021-11-06","2021-10-07","2021-10-07","2022-09-04","2022-08-22","2021-11-06","2021-11-06","2021-11-06","2022-08-22","2022-08-22","2022-09-04","2022-08-22","2020-05-10","2020-08-19","2020-08-19","2020-08-19","2022-06-26","2022-06-26","2022-07-26","2022-07-26","2022-09-04","2022-09-04","2022-09-04","2022-09-04","2022-09-04","2022-09-04","2020-03-29","2022-01-03","2022-01-03","2022-08-17","2022-01-03","2022-01-03","2021-10-07","2021-11-06","2022-07-26","2022-08-17","2022-08-17"],"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":[]},{"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":[["","67877056105","METFORMIN","TAB 500MG","30","Select","Select",""],["","00904759161","FERROUS","TAB 325MG","30","Select","Select",""],["","24208091019","ERYTHROMYCIN","OIN 5MG\/GM","3","Select","Select",""],["","11822365670","ACETAMIN","TAB 500MG","20","Select","Select",""],["","51672130005","AMMONIUM","LOT 0.12","450","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","60","Select","Select",""],["","65162019010","NAPROXEN","TAB 500MG","20","Select","Select",""],["","13668001001","CITALOPRAM","TAB 20MG","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":""}]}]}