{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASERETSDOOW ","gend":1,"add":"WED 38391RD YRREB","city":"BRISTOL","state":"VA","zip":"24202-9998","dob":"1972-04-10","age":"","mstatus":"","insh":"14500210*95","cliId":"","pno":"66\/6721757-9","cno":"276\/669-7571","email":"","ename":"","eno":"","pphy":"ANDREWS, ROY R DO","ppno":"276\/669-5179","pcpadd":"2195 EUCLID AVE","pcpcity":"BRISTOL","pcpstate":"VA","pcpzip":24201,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","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":["M79.605","L40.9","R79.82","E55.9","F41.1","F40.01","F51.05","M51.36","K21.9","R70.0","J06.9","Z01.419","Z12.31","N95.1","F33.2","E66.01","Z87.2","Z68.43","Z23.","M79.671","M79.672","Z90.710","Z71.89","Z01.818","Z87.891","R63.5","E63.9","Z86.2","Z87.19","R73.09","R21.","K80.20","L40.0","Z79.899","F33.40","F41.9","F50.9","F54.","L98.9","Z71.3"],"date":["2020-01-13","2020-08-17","2020-02-20","2021-02-15","2022-09-26","2020-02-20","2021-02-15","2021-02-15","2021-02-15","2020-01-13","2020-01-13","2020-06-22","2020-06-22","2020-06-22","2022-09-26","2021-02-15","2021-02-15","2021-02-03","2020-10-19","2020-10-19","2020-10-19","2020-02-20","2021-01-27","2021-02-15","2020-04-27","2020-04-27","2020-04-27","2020-04-27","2020-04-27","2020-04-27","2020-04-21","2020-06-25","2020-01-29","2020-01-29","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2021-02-03"],"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":[["","29300022701","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","24979010107","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","16714073301","CELECOXIB","CAP 200MG","60","Select","Select",""],["","62175061746","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00555088602","ESTRADIOL","TAB 1MG","90","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","65862022660","CLARITHROMYC","TAB 500MG","14","Select","Select",""],["","59746021106","CYCLOBENZAPR","TAB 5MG","90","Select","Select",""],["","00074153903","HUMIRA","KIT PS\/UV","3","Select","Select",""],["","00168005615","BETAMETH","OIN 0.0005","15","Select","Select",""],["","59762330401","NITROGLYCERN","SUB 0.4MG","100","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":""}]}]}