{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   INATTIRBOCSICNARF E","gend":1,"add":"ARA 6118NL NAIB","city":"CATAWBA","state":"VA","zip":"24070-9998","dob":"1986-07-30","age":"","mstatus":"","insh":"0735110*88","cliId":"","pno":"98\/0453806-2","cno":"540\/765-2103","email":"","ename":"","eno":"","pphy":"THOMAS II, WILLIAM D DO","ppno":"540\/382-6148","pcpadd":"6 HICKOK STREET","pcpcity":"CHRISTIANSBURG","pcpstate":"VA","pcpzip":24073,"pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","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":["J06.9","F31.30","F31.9","F41.3","G43.009","F90.2","F11.20","R11.2","R19.7","R12.","F15.20","F31.4","F11.90","Z51.81","Z79.899","R53.83","J02.9","NO DATA","J01.00","F51.01","K21.0","R11.0","R10.11","F41.1","G56.03","M41.9","J30.89","K59.03","M54.9","N39.0","V62.84","F19.10","Z20.822","F31.63","R07.89","F11.21","R76.8","R01.1","E78.2","Q21.0","R10.13","F43.9","R46.2","F31.32","J30.9","E87.6","R30.0","B86.","R07.2","Z82.49","F17.210","R51.","K08.89","Z76.0"],"date":["2019-02-27","2019-05-16","2021-11-02","2021-11-02","2021-11-02","2021-12-20","2021-12-28","2019-10-17","2019-10-17","2019-10-17","2021-06-09","2021-06-09","2021-04-08","2021-12-17","2021-12-17","2021-11-02","2021-11-02","2021-11-02","2019-01-22","2020-02-19","2020-02-19","2019-10-24","2021-05-24","2021-03-25","2019-05-28","2019-04-30","2019-04-30","2019-04-30","2020-01-08","2020-10-25","2021-02-12","2021-02-12","2021-02-12","2021-02-14","2021-02-14","2021-05-28","2021-12-20","2021-12-20","2021-12-20","2019-01-30","2019-01-07","2020-11-30","2021-02-13","2021-05-21","2020-02-19","2021-01-22","2021-01-22","2021-01-22","2019-01-30","2019-01-30","2021-04-08","2019-09-01","2019-09-01","2021-04-08"],"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":[["","","ARIPIPRAZOLE"," ARIPIPRAZOLE ","30","Select","Select",""],["","","GABAPENTIN"," GABAPENTIN ","90","Select","Select",""],["","","BROM\/PSE\/DM"," BROM\/PSE\/DM ","180","Select","Select",""],["","","TROKENDI"," TROKENDI ","30","Select","Select",""],["","","LEVOFLOXACIN"," LEVOFLOXACIN ","10","Select","Select",""],["","","CITALOPRAM"," CITALOPRAM ","30","Select","Select",""],["","","SUMATRIPTAN"," SUMATRIPTAN ","10","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","10","Select","Select",""],["","","PROMETHAZINE"," PROMETHAZINE ","15","Select","Select",""],["","","PANTOPRAZOLE"," PANTOPRAZOLE ","30","Select","Select",""],["","","DOXYCYCL"," DOXYCYCL ","20","Select","Select",""],["","","CYCLOBENZAPR"," CYCLOBENZAPR ","30","Select","Select",""],["","","AMPHET\/DEXTR"," AMPHET\/DEXTR ","30","Select","Select",""],["","","AMITIZA"," AMITIZA ","60","Select","Select",""],["","","TOPIRAMATE"," TOPIRAMATE ","60","Select","Select",""],["","","QUETIAPINE"," QUETIAPINE ","60","Select","Select",""],["","","LEVOCETIRIZI"," LEVOCETIRIZI ","30","Select","Select",""],["","","CEPHALEXIN"," CEPHALEXIN ","21","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","CLINDAMYCIN"," CLINDAMYCIN ","2","Select","Select",""],["","","ESOMEPRA"," ESOMEPRA ","30","Select","Select",""],["","","EMGALITY"," EMGALITY ","2","Select","Select",""],["","","DULOXETINE"," DULOXETINE ","30","Select","Select",""],["","","RANITIDINE"," RANITIDINE ","30","Select","Select",""],["","","CIPROFLOXACN"," CIPROFLOXACN ","14","Select","Select",""],["","","ANTI-DIARRHE"," ANTI-DIARRHE ","30","Select","Select",""],["","","LANSOPRAZOLE"," LANSOPRAZOLE ","30","Select","Select",""],["","","IBUPROFEN"," IBUPROFEN ","30","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","30","Select","Select",""],["","","ORPHENADRINE","TAB 100MG ER","","Select","Select",""],["","","ALLERGY","TAB 180MG","","Select","Select",""],["","","TRAZODONE","TAB 150MG","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","IBU","TAB 800MG","","Select","Select",""],["","","HYDROXYZ","CAP 50MG","","Select","Select",""],["","","FAMOTIDINE","TAB 40MG","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","","DEXAMETHASON","TAB 4MG","","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","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":""}]}]}