{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  EINAHPETSNAMKROW L ","gend":1,"add":"NOSKCAJ 2771EKPT REVIR ","city":"HOT SPRINGS","state":"VA","zip":"24445-9998","dob":"1975-02-17","age":"","mstatus":"","insh":"24000910*921","cliId":"","pno":"38\/0454703-9","cno":" ","email":"","ename":"","eno":"","pphy":"MONROE, JULIE DO","ppno":"540\/962-1122","pcpadd":"322 W RIVERSIDE ST","pcpcity":"COVINGTON","pcpstate":"VA","pcpzip":24426,"pcpcounty":"","pcpid":"","pcpname":"BATH COUNTY COMMUNITY HOSPITAL","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"ROANOKE ALLEGHANY","aligned":"Y","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":["Z00.00","F32.9","E55.9","G37.9","B37.83","Z13.6","G35.","E66.01","K59.00","F39.","L02.416","E78.5","F41.9","F32.A","N64.9","F33.2","R51.9","G24.4","F45.8","U07.1","R03.0","G98.8","M26.609","K04.7","F17.210","Z20.822","J01.20","F19.90"],"date":["2021-03-31","2021-12-03","2022-09-19","2021-03-31","2021-03-31","2021-03-31","2022-10-17","2021-06-17","2021-12-03","2021-10-08","2021-09-22","2022-04-13","2022-07-15","2022-07-15","2022-07-15","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2022-08-23","2022-08-23","2022-08-23","2022-10-17","2022-04-19","2022-04-19","2022-10-18","2022-10-18","2022-06-01"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"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":[["","64406000602","TECFIDERA","CAP 240MG","60","Select","Select",""],["","70436005901","BUPROPION HYDROCHLORIDE ER (SR)","TAB 150MG SR","-90","Select","Select",""],["","65862019405","FLUOXETINE HYDROCHLORIDE","CAP 40MG","30","Select","Select",""],["","67877022205","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","31722065832","DIMETHYL FUMARATE","CAP 240MG DR","180","Select","Select",""],["","29300016815","TIZANIDINE HCL","TAB 2MG","-270","Select","Select",""],["","60505015701","BUPROPION HCL","TAB 100MG","90","Select","Select",""],["","00168025815","CLOTRIMAZOLE\/BETAMETHASONE DIPROPIONATE","CRE DIPROP","60","Select","Select",""],["","65162089703","ARIPIPRAZOLE","TAB 5MG","50","Select","Select",""],["","00115180301","HYDROXYZINE PAMOATE","CAP 25MG","30","Select","Select",""],["","80777027310","MODERNA COVID-19 VACCINE","INJ COVID-19","0","Select","Select",""],["","00143980350","DOXYCYCLINE HYCLATE","CAP 100MG","20","Select","Select",""],["","49281042150","FLUZONE QUADRIVALENT 2021-2022","INJ 2021-22","0","Select","Select",""],["","69238126601","OSELTAMIVIR PHOSPHATE","CAP 75MG","10","Select","Select",""],["","23155050101","HYDROXYZINE HYDROCHLORIDE","TAB 25MG","90","Select","Select",""],["","65862018601","CLINDAMYCIN HYDROCHLORIDE","CAP 300MG","21","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","1","Select","Select",""],["","23155013525","DOXYCYCLINE MONOHYDRATE","TAB 100MG","14","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}