{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YRREJYROME C","gend":0,"add":"NUD 4117DAOR NAC","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1958-05-04","age":"","mstatus":"","insh":"0462210*49","cliId":"","pno":"98\/4085686-2","cno":"804\/892-6865","email":"","ename":"","eno":"","pphy":"RUSSELL, AMANDA MD","ppno":"804\/469-3731","pcpadd":"13855 COURTHOUSE ROAD","pcpcity":"DINWIDDIE","pcpstate":"VA","pcpzip":23841,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J93.9","E87.1","J44.9","I10.","S22.42XA","S27.0XXA","J96.01","D72.829","F10.10","F17.210","J43.9","S22.43XA","Z79.51","Z79.899","J96.91","J44.1","F17.200","J20.9","Z72.0"],"date":["2022-10-22","2022-10-21","2022-10-28","2022-10-21","2022-10-21","2022-10-21","2022-10-22","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2020-09-13","2020-09-13","2020-09-11","2020-09-12","2020-09-12"],"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":[["","59310057922","PROAIR","AER ","8","Select","Select",""],["","72205000390","ROSUVASTATIN","TAB 10MG","30","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","67618010160","COLACE","CAP 100MG","5","Select","Select",""],["","55111046705","METOPROL","TAB 50MG ER","30","Select","Select",""],["","67877019810","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","65862090801","CELECOXIB","CAP 100MG","10","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","5","Select","Select",""],["","00363410040","STOOL","CAP 100MG","5","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","5","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","15","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","43547035611","LISINOPRIL","TAB 40MG","90","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","10","Select","Select",""],["","65862064163","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00536589588","NICOTINE","DIS 14MG\/24H","28","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":""}]}]}