{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   EISSACNITRAM M","gend":1,"add":"LNOOM 3818DAOR THGI","city":"SMITHFIELD","state":"VA","zip":"23430-9998","dob":"2004-02-05","age":"","mstatus":"","insh":"9671910*05","cliId":"","pno":"73\/7572384-1","cno":"757\/279-0336","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":["J45.20","Z68.51","L50.3","L50.2","J30.1","J30.89","G44.209","B34.9","B07.8","R53.83","Z68.54","J30.9","N30.00","S91.311A","Z77.22","F32.9","Z30.40","Z68.35","Z87.09","L50.9","R93.89","N92.0","Z30.011","R05.","J31.0","M79.672","M79.671","M72.2"],"date":["2021-08-31","2021-09-30","2020-05-05","2020-05-05","2020-05-05","2020-05-05","2021-09-30","2019-10-21","2019-10-21","2019-10-21","2019-10-21","2020-09-18","2021-01-08","2019-02-11","2019-02-11","2021-03-11","2021-03-11","2021-03-11","2019-10-22","2019-10-22","2020-09-14","2020-09-14","2020-09-14","2019-10-22","2019-10-22","2020-09-29","2020-09-29","2020-09-29"],"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":[["","","VENTOLIN"," VENTOLIN ","18","Select","Select",""],["","","CEPHALEXIN"," CEPHALEXIN ","28","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","8","Select","Select",""],["","","CETIRIZINE"," CETIRIZINE ","30","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","ALLEGRA","TAB 180MG","","Select","Select",""],["","","CVS","TAB 180MG","","Select","Select",""],["","","NIKKI","TAB 3-0.02MG","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","","FEXOFENADINE","TAB 180MG","","Select","Select",""],["","","EYE","DRO 0.025%OP","","Select","Select",""],["","","JUNEL","TAB 43831","","Select","Select",""],["","","FLOVENT","AER 110MCG","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","MONTELUKAST","CHW 5MG","","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":""}]}]}