{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YRRALHTIEK","gend":0,"add":"NEB EGROEG 82EVIRD DETIHW ","city":"LEBANON","state":"VA","zip":24266,"dob":"1962-08-10","age":"","mstatus":"","insh":"60013270","cliId":"","pno":"5267299194","cno":2762549199,"email":"","ename":"","eno":"","pphy":"HARMAN, NICHOLAS","ppno":2762549199,"pcpadd":"16419 WISE ST,","pcpcity":"SAINT PAUL","pcpstate":"VA","pcpzip":24283,"pcpcounty":"","pcpid":"","pcpname":"C HEALTH PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"28 GEORGE BEN WHITED DRIVE","add3":"","madd1":"28 GEORGE BEN WHITED DRIVE","madd2":"APARTMENT 2","madd3":"","mcity":"LEBANON","mstate":"VA","mzip":"24266-6158","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.9","I10","K21.9","E55.9","E78.2","D45","J18.9","R06.89","E86.0","E83.42","E87.2","E78.5","Z87.891","N17.9","J15.9","J96.11","R06.00","S29.9XXA","J44.1","J96.01","E87.1","G40.909","I95.9","J44.0","K59.00","I25.2","R09.02","R68.89","J45.909","R10.13","R04.0","E66.9","I70.0","R05","J96.21","I50.32","I27.29","I11.0","G47.33","R94.31","Z68.32","Z99.81","Z79.51","Z79.899","R06.02","J96.00","I50.9","F17.200","F10.99","I50.33","I11.9","F10.20","D58.2","R07.81","R07.9","V29.9XXA","S80.211A","S80.212A","S60.511A","F17.210","V00.838A","V00.831A","R73.09","Z00.00","Z12.5","E11.9","E83.52","K64.4","K92.1","K64.2","D12.8","K63.5","K57.30","D12.3","D12.4","K64.8","K62.1","K64.9","D75.1","D12.5","M19.90","D72.1","D72.810","D72.89","Z09","E78.00","Z11.59","G35","R60.0","H53.453","Z72.0","R03.0","Z79.82","R91.8","G44.1","J81.0","R91.1","E66.01","I27.20","I51.7","Z82.49","J96.20","R42"],"date":["2022-03-29","2022-03-29","2022-03-29","2020-07-14","2022-03-29","2022-03-29","2020-03-10","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2021-06-07","2021-06-06","2020-03-02","2020-03-01","2021-09-16","2020-03-01","2021-07-11","2021-06-07","2021-06-07","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2020-03-02","2021-09-16","2021-06-06","2020-03-10","2021-08-08","2020-12-08","2021-06-06","2021-06-07","2021-06-06","2021-06-06","2021-06-06","2021-06-08","2021-06-06","2021-06-08","2021-06-07","2021-06-06","2021-06-06","2021-06-08","2021-06-06","2021-06-06","2021-06-06","2021-06-06","2021-06-06","2021-06-08","2021-06-06","2021-06-07","2021-06-07","2021-06-07","2022-03-29","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-07-11","2021-11-24","2022-02-01","2022-02-01","2022-03-29","2022-04-06","2019-02-26","2019-03-13","2019-03-27","2019-03-13","2019-03-13","2019-03-20","2019-03-20","2019-03-20","2019-03-27","2019-03-20","2019-04-02","2019-04-02","2019-03-20","2019-03-27","2019-04-02","2019-04-02","2019-04-02","2019-04-02","2019-08-13","2019-08-13","2019-08-27","2019-09-10","2019-08-27","2019-09-05","2019-08-29","2019-09-05","2019-08-29","2019-09-05","2019-09-05","2019-09-06","2019-09-05","2019-09-05","2019-09-06","2019-09-05","2019-09-05","2019-09-05"],"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":[["","50228014601","HYDROCHLOROT","50228014601 HYDROCHLOROT ","30","Select","Select",""],["","00406012310","HYDROCO\/APAP","00406012310 HYDROCO\/APAP ","6","Select","Select",""],["","67877019905","AMLODIPINE","67877019905 AMLODIPINE ","30","Select","Select",""],["","68180047903","SIMVASTATIN","68180047903 SIMVASTATIN ","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","65862056099 PANTOPRAZOLE ","60","Select","Select",""],["","68180096301","ALBUTEROL","68180096301 ALBUTEROL ","8.5","Select","Select",""],["","65862086001","FAMOTIDINE","65862086001 FAMOTIDINE ","30","Select","Select",""],["","00904582460","VITAMIN","00904582460 VITAMIN ","180","Select","Select",""],["","24385002868","GNP","24385002868 GNP ","30","Select","Select",""],["","59746017310","PREDNISONE","59746017310 PREDNISONE ","21","Select","Select",""],["","59762040105","SUCRALFATE","59762040105 SUCRALFATE ","120","Select","Select",""],["","16103036611","ASPIRIN","16103036611 ASPIRIN ","30","Select","Select",""],["","00781808926","AZITHROMYCIN","00781808926 AZITHROMYCIN ","6","Select","Select",""],["","76204060005","IPRATROPIUM\/","76204060005 IPRATROPIUM\/ ","360","Select","Select",""],["","00536589688","NICOTINE","00536589688 NICOTINE ","28","Select","Select",""],["","00310460012","BEVESPI","AER 9-4.8MCG","10.7","Select","Select",""],["","00186037020","SYMBICORT","00186037020 SYMBICORT ","10.2","Select","Select",""],["","80777027310","MODERNA","80777027310 MODERNA ","0.5","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","1.00","Select","Select",""],["","24385032521","NASAL","24385032521 NASAL ","44","Select","Select",""],["","42571016242","AMOX\/K","42571016242 AMOX\/K ","20","Select","Select",""],["","69452014330","BENZONATATE","CAP 100MG","30","Select","Select",""],["","51991045758","POLYETH","POW 3350 NF","255","Select","Select",""],["","00904792760","BISACODYL","TAB 5MG EC","4","Select","Select",""],["","68001036206","CEFDINIR","CAP 300MG","10","Select","Select",""],["","24385067510","MAG","SOL LEMON","592","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":""}]}]}