{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EH AISANOSREDN","gend":1,"add":"WBOB 701NL ETIH","city":"LANCASTER","state":"VA","zip":"22503-9998","dob":"1989-10-14","age":"","mstatus":"","insh":"09200210*30","cliId":"","pno":"27\/4086863-4","cno":"","email":"","ename":"","eno":"","pphy":"CORSA, ERIN NP","ppno":"804\/462-5155","pcpadd":"36 LIVELY OAKS ROAD","pcpcity":"LIVELY","pcpstate":"VA","pcpzip":22507,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS LIVELY MEDICAL CENTER","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["H10.32","J45.41","R10.9","R11.10","NO DATA","Z47.89","N30.01","B96.89","R51.","Z20.822","R05.","M54.5","Z23.","Z80.3","I10.","F33.9","R05.9","R53.83","G43.111","Z68.24","Z20.2","J02.9","R92.8","Z01.411","Z31.69","F17.200","N92.6","R10.32","A59.00","Z32.02","V58.89","Z11.3","R10.2","G89.29","Z98.1","Z87.81","R20.9","T84.193A","Z30.42","V54.12","T84.84XA","Z47.2","M25.532","A08.4","K21.9","R10.30","N94.10","R11.0","N89.8","S63.502A","Y04.8XXA","K29.90","G56.02","S52.502A","R20.0","R11.2","R20.2","G89.18"],"date":["2020-09-30","2020-09-30","2021-12-01","2021-01-13","2021-10-26","2020-01-28","2020-08-23","2020-08-23","2020-08-23","2021-08-09","2021-08-09","2020-09-29","2020-12-01","2020-12-01","2021-10-26","2020-12-01","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-08-13","2021-11-02","2020-12-22","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2021-10-26","2019-02-07","2019-03-04","2019-11-05","2019-11-05","2019-11-05","2019-11-05","2019-11-07","2019-11-07","2019-08-19","2019-12-02","2019-12-02","2019-12-02","2019-12-19","2019-03-05","2019-10-31","2019-01-31","2019-01-31","2019-01-31","2019-01-31","2019-08-03","2019-08-03","2019-03-07","2019-09-26","2019-09-26","2019-09-26","2019-03-07","2019-10-23","2019-12-02"],"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":[["","59746011506","PROCHLORPER","TAB 10MG","12","Select","Select",""],["","51672400102","NORTRIPTYLIN","CAP 10MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","50111078810","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","","BUT\/APAP\/CAF","CAP ","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","AMLODIPINE","TAB 5MG","","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68382039801","POT  CHLORIDE","TAB 20MEQ ER","10","Select","Select",""],["","67877022301","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00054001829","PREDNISONE","TAB 20MG","6","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","OFLOXACIN","DRO 0.3%OTIC","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","65162025350","RANITIDINE","TAB 150MG","7","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","15","Select","Select",""],["","00591299239","PHENADOZ","SUP 25MG","12","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","6","Select","Select",""],["","68645049254","PANTOPRAZOLE","TAB 40MG","20","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","15","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","49035019402","EQ","DIS 21MG\/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":[]}},{"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":""}]}]}