{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  HAROBEDXODDAM N ","gend":1,"add":"OB OP806 X","city":"BRACEY","state":"VA","zip":"23919-9998","dob":"1951-06-08","age":"","mstatus":"","insh":"24000910*439","cliId":"","pno":"19\/4341443-7","cno":"","email":"","ename":"","eno":"","pphy":"VIGILANTE, PAULA E NP","ppno":"434\/636-6903","pcpadd":"9782 HIGHWAY NINE O THREE","pcpcity":"BRACEY","pcpstate":"VA","pcpzip":23919,"pcpcounty":"","pcpid":"","pcpname":"MCV ASSOCIATED PHYSICIANS","plan":"OHP","program":"MEDICARE","lob":"MA-Non DSNP","region":"CENTRAL","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":["Z23.","G50.1","H69.92","M70.62","J45.901","Z79.899","M25.552","M70.60","Z00.00","E78.5","F41.9","M81.0","E55.9","M54.9","Z13.1","J45.909","M75.42","Z12.11","M19.012","M54.16","U07.1","K43.9","J06.9","M62.08","Z20.822","J45.21","Z79.51","M53.3","G89.29"],"date":["2022-11-17","2021-06-25","2021-06-25","2022-11-17","2021-01-04","2022-10-26","2021-08-31","2021-08-31","2021-03-22","2021-03-22","2021-03-22","2021-04-29","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2021-03-22","2022-07-13","2021-04-29","2022-04-26","2022-08-10","2022-05-05","2022-03-03","2022-04-07","2022-04-19","2022-10-26","2022-10-26","2022-11-17","2022-11-17"],"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":{"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":[["","59310057922","PROAIR","AER ","8","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00115168774","BUDESONIDE","SUS 0.25MG\/2","120","Select","Select",""],["","55111064530","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","72205000390","ROSUVASTATIN","TAB 10MG","90","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","42","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","40","Select","Select",""],["","69097022416","ALENDRONATE","TAB 70MG","12","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","540","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00005197102","PREVNAR","INJ ","0","Select","Select",""],["","00121077516","GG\/CODEINE","SOL 100-10\/5","-120","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","00006505506","LAGEVRIO","CAP 200MG","40","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}