{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"OC SIVARTRS NARHC","gend":0,"add":"                         EVIRD                              ","city":"RAVEN                         ","state":"VA","zip":"24639-0008","dob":"1982-11-04","age":"","mstatus":"","insh":"81013243","cliId":"","pno":"7967294431","cno":2762029608,"email":"","ename":"","eno":"","pphy":"TITHA, RAVI K","ppno":2769646711,"pcpadd":"3150 CLINCH ST","pcpcity":"RICHLANDS                     ","pcpstate":"VA","pcpzip":246412159,"pcpcounty":"","pcpid":"P9120204","pcpname":"RAVI K TITHA MD","ano":"","add2":"PO BOX 8                                                    ","add3":"","madd1":"DRIVE                                                       ","madd2":"PO BOX 8                                                    ","madd3":"","mcity":"RAVEN                         ","mstate":"VA","mzip":"24639-0008","pcpfaxno":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"SOUTHWEST","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K76.0","R16.1","E11.9","Z72.0","D72.829","R10.819","N32.89","R79.82","R59.9","F10.21","R79.9","R10.12","J02.9","I10","Z12.11","M54.31","M25.551","M54.5","Z79.84","Z79.899","F17.210","M54.41","K59.1","F17.200","M54.32","M54.30","M79.605","M79.604","Z90.49","S22.31XA","R07.81","W11.XXXA","S29.9XXA","R07.89","R07.9","S20.211A","W19.XXXA","A08.4","J06.9","R09.82","R52","R68.83","R11.0","Z20.828","R05","R11.2","K59.00","R00.0","K52.9","J01.10","H66.93","R07.82","R06.02","S61.241A","S69.92XA","W45.0XXA","Z23","X58.XXXA","Z04.89","B34.9","R68.89","R51.9","Z20.822","K02.9","Z87.898","Z80.0","Z91.19"],"date":["2019-11-04","2019-11-07","2021-10-20","2019-11-04","2019-11-04","2019-11-04","2019-11-04","2019-11-04","2019-11-04","2019-11-04","2019-11-04","2020-01-03","2021-04-05","2021-10-20","2020-03-26","2020-06-26","2020-06-18","2020-06-18","2021-10-19","2021-10-19","2021-10-19","2020-06-18","2020-06-18","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2020-06-26","2021-01-07","2020-07-10","2020-08-15","2020-07-10","2020-07-10","2021-10-19","2021-10-19","2020-08-14","2020-08-14","2020-10-08","2021-09-23","2020-11-19","2020-11-19","2020-11-19","2021-10-19","2020-11-19","2020-11-19","2020-11-19","2020-12-11","2021-01-07","2021-03-05","2021-04-05","2021-04-05","2021-05-13","2021-05-13","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-26","2021-09-23","2021-10-19","2021-10-19","2021-10-20","2021-10-20","2021-10-20","2021-10-20"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","31722094305","HYDROCO\/APAP","10-325MG","20","Select","Select",""],["","55111068405","IBU","800MG","60","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","21","Select","Select",""],["","42571016142","AMOX\/K","500-125","21","Select","Select",""],["","67877021905","CEPHALEXIN","500MG","28","Select","Select",""],["","65162054150","CYCLOBENZAPR","10MG","10","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","15","Select","Select",""],["","68462019005","NAPROXEN","500MG","15","Select","Select",""],["","65862064169","AZITHROMYCIN","250MG","6","Select","Select",""],["","57237003105","AMOXICILLIN","500MG","20","Select","Select",""],["","68180098003","LISINOPRIL","10MG","30","Select","Select",""],["","57237010001","METOPROL","25MG","60","Select","Select",""],["","51224000760","METFORMIN","500MG ER","360","Select","Select",""],["","00310621030","FARXIGA","10MG","30","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","76385012350","METHOCARBAM","500MG","60","Select","Select",""],["","49483060450","IBUPROFEN","800MG","30","Select","Select",""],["","67877057305","BENZONATATE","100MG","30","Select","Select",""],["","31722094305","HYDROCO\/APAP ","TAB 10-325MG","20","Select","Select",""],["","55111068405","IBU ","TAB 800MG","60","Select","Select",""],["","65862039010","ONDANSETRON ","TAB 4MG ODT","21","Select","Select",""],["","42571016142","AMOX\/K ","TAB 500-125","21","Select","Select",""],["","51224000760","METFORMIN ","TAB 500MG ER","120","Select","Select",""],["","68180098003","LISINOPRIL ","TAB 10MG","30","Select","Select",""],["","65862001501","AMOXICILLIN ","TAB 875MG","30","Select","Select",""],["","67877021905","CEPHALEXIN ","CAP 500MG","28","Select","Select",""],["","65162054150","CYCLOBENZAPR ","TAB 10MG","10","Select","Select",""],["","00591079501","DICYCLOMINE ","TAB 20MG","15","Select","Select",""],["","68462019005","NAPROXEN ","TAB 500MG","15","Select","Select",""],["","65862064169","AZITHROMYCIN ","TAB 250MG","6","Select","Select",""],["","57237010001","METOPROL ","TAB 25MG","60","Select","Select",""],["","00310621030","FARXIGA ","TAB 10MG","30","Select","Select",""],["","00093031401","KETOROLAC ","TAB 10MG","20","Select","Select",""],["","76385012350","METHOCARBAM ","TAB 500MG","60","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","67877057305","BENZONATATE ","CAP 100MG","30","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}