{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"W   TREBORRJ HTIMS ","gend":0,"add":"TSAE 1247DR REVIR ","city":"KING WILLIAM","state":"VA","zip":"23086-9998","dob":"1965-03-06","age":"","mstatus":"","insh":"15300210*80","cliId":"","pno":"62\/4085732-3","cno":"804\/263-2375","email":"","ename":"","eno":"","pphy":"ROSE, ROBERT MD","ppno":"804\/746-1677","pcpadd":"1041 SHARON ROAD SUITE 205","pcpcity":"KING WILLIAM","pcpstate":"VA","pcpzip":23086,"pcpcounty":"","pcpid":"","pcpname":"AYLETT 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":["I48.91","I10.","E66.01","I50.9","Z68.45","G47.33","I15.8","N18.3","N42.9","M1A.9XX1","E78.5","R73.02","I48.0","J45.20","I89.0","J45.909","I25.10","I11.0","E78.00","E66.9","G47.30","Z79.899","Z87.891","M79.89","E78.2","NO DATA","R94.30"],"date":["2021-06-15","2021-06-15","2021-10-19","2021-10-19","2021-10-19","2021-10-27","2021-10-27","2020-03-25","2021-05-21","2021-05-21","2021-05-21","2021-05-21","2021-05-21","2020-03-25","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-10-19","2021-06-15","2021-05-21","2019-09-27"],"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":[["","","XARELTO"," XARELTO ","30","Select","Select",""],["","","COLCHICINE"," COLCHICINE ","30","Select","Select",""],["","","CETIRIZINE"," CETIRIZINE ","30","Select","Select",""],["","59467031801","MITIGARE","CAP 0.6MG","30","Select","Select",""],["","","DOFETILIDE"," DOFETILIDE ","30","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","","ALLOPURINOL"," ALLOPURINOL ","180","Select","Select",""],["","","CARVEDILOL"," CARVEDILOL ","60","Select","Select",""],["","","ISOSORB"," ISOSORB ","90","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","7","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","","RANITIDINE"," RANITIDINE ","60","Select","Select",""],["","","HYDRALAZINE"," HYDRALAZINE ","120","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","FAMOTIDINE","TAB 40MG","","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":""}]}]}