{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YELRIHSKCOLLUB A","gend":1,"add":"NE 631TS YLD","city":"CHASE CITY","state":"VA","zip":"23924-9998","dob":"1957-02-17","age":"","mstatus":"","insh":"94000910*086","cliId":"","pno":"62\/4349053-2","cno":"","email":"","ename":"","eno":"","pphy":"TITUS, GARETH MD","ppno":"434\/572-8977","pcpadd":"2232 WILBORN AVENUE","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":"","pcpname":"HALIFAX HEART CENTER PC","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":["R06.00","G47.33","M79.604","I10.","E66.01","R79.89","Z68.42","E55.9","E78.2","R06.83","R06.02","R06.01","R06.09","R00.2","Z79.899","H40.053","H04.123","H52.4","N30.01","M43.16","M51.26","G47.30","R60.0","R07.89","R94.31","Z00.00","M54.41","G89.29","I08.1","E78.5","Z82.49","R41.3","Z12.31"],"date":["2022-05-09","2022-08-31","2022-08-31","2022-10-20","2022-10-20","2022-10-20","2022-10-20","2022-10-20","2022-10-20","2022-05-09","2022-05-09","2022-05-09","2022-10-07","2022-07-08","2022-08-10","2022-07-11","2022-07-11","2022-07-11","2022-08-23","2022-07-27","2022-04-12","2022-06-03","2022-05-17","2022-05-31","2022-05-17","2022-06-21","2022-07-27","2022-07-27","2022-08-08","2022-08-08","2022-08-08","2022-10-25","2022-11-16"],"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":[]},{"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":[["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","90","Select","Select",""],["","68382079101","ACYCLOVIR","TAB 400MG","180","Select","Select",""],["","10702002901","PHENTERMINE","CAP 37.5MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","71093011105","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","68382002310","ATENOLOL","TAB 50MG","90","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","49281012265","FLUZONE","INJ 2022-23","1","Select","Select",""],["","59779008001","ATHLETE","CRE 0.01","15","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","90","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":""}]}]}