{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ANOHSTHGIRW R","gend":1,"add":"OORB 1341YWH LAENK","city":"RUSTBURG","state":"VA","zip":"24588-9998","dob":"1988-04-02","age":"","mstatus":"","insh":"1377110*78","cliId":"","pno":"74\/4343451-1","cno":"434\/471-1543","email":"","ename":"","eno":"","pphy":"KILEL, JENNIFER NP","ppno":"434\/947-5967","pcpadd":"320 FEDERAL ST","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24504,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","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":["Z51.11","C81.70","Z20.828","R87.619","R87.810","Z32.02","F43.23","F41.9","Z51.5","G89.3","C85.90","C81.90","M79.601","G62.89","B34.9","M25.511","R20.0","R20.2","F11.90","F51.05","F41.8","F32.9","N83.9","D27.0","R19.09","K21.9","O20.0"],"date":["2022-10-20","2022-10-20","2021-02-28","2021-11-01","2021-11-01","2021-11-01","2022-07-14","2022-09-16","2022-09-16","2022-09-16","2022-03-22","2022-09-16","2021-11-11","2021-11-11","2021-02-28","2021-09-27","2021-10-11","2021-09-27","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2021-11-17","2021-11-17","2021-11-17","2020-06-23","2022-09-28"],"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":[["","10370010150","BUPROPN","TAB 150MG XL","60","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","210","Select","Select",""],["","67877075460","DRONABINOL","CAP 5MG","90","Select","Select",""],["","16729020301","BUSPIRONE","TAB 15MG","30","Select","Select",""],["","68180088673","NIKKI","TAB 3-0.02MG","28","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","55111056430","ATOMOXETINE","CAP 100MG","30","Select","Select",""],["","65862092585","INCASSIA","TAB 0.35MG","84","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","25","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00093585205","ESCITALOPRAM","TAB 20MG","90","Select","Select",""],["","31722077805","ACYCLOVIR","TAB 800MG","180","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","90","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","65862048901","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","180","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","47781040960","HYDROCODONE","CAP 10MG ER","12","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","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":["",""],"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":""}]}]}