{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L   YNOTNOTLAD ","gend":0,"add":"SEULB 1075DAOR GNIRP","city":"HIWASSEE","state":"VA","zip":"24347-9998","dob":"1968-08-26","age":"","mstatus":"","insh":"16200210*71","cliId":"","pno":"55\/4053443-3","cno":"","email":"","ename":"","eno":"","pphy":"AKERS, MORGAN P NP","ppno":"540\/381-0820","pcpadd":"215 ROANOKE STREET","pcpcity":"CHRISTIANSBURG","pcpstate":"VA","pcpzip":"24073","pcpcounty":"","pcpid":"","pcpname":"FREE CLINIC OF THE NEW RIVER VALLEY INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["G43.011","M79.89","M77.8","W22.8XXA","G43.909","M54.5","M54.16","M70.62","E11.9","I08.3","R42.","S29.011A","X58.XXXA","H52.4","H18.413","H04.123","H52.13","H52.223","Z79.4","I65.23","I08.2","I10.","M79.672","G44.52","Z12.11","K57.30","M72.2","J01.41","R94.31","M54.2","E11.42","J01.40","K21.9","Z23."],"date":["2021-03-23","2020-09-01","2020-11-30","2020-11-30","2021-10-28","2021-06-04","2021-06-04","2021-06-04","2021-09-01","2020-11-17","2020-11-17","2020-12-05","2020-12-05","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2020-10-12","2020-11-17","2020-11-17","2021-02-17","2021-10-28","2020-02-17","2020-02-17","2021-01-06","2021-03-23","2020-12-05","2020-12-05","2021-02-09","2021-02-09","2021-02-09","2021-05-06"],"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":[["","00781261305","AMOXICILLIN","CAP 500MG","60","Select","Select",""],["","65862085999","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","55111029309","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","70710122600","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","59762232201","ELETRIPTAN","TAB 40MG","6","Select","Select",""],["","00023650110","UBRELVY","TAB 100MG","10","Select","Select",""],["","00049234045","RELPAX","TAB 40MG","9","Select","Select",""],["","51759020410","AJOVY","INJ 225\/1.5","4","Select","Select",""],["","57237008663","RIZATRIPTAN","TAB 10MG ODT","9","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","90","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","70377003014","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","90","Select","Select",""],["","08396900218","PEN  NEEDLES","MIS 31GX8MM","100","Select","Select",""],["","53885004601","ONETOUCH","KIT ULTRA 2","1","Select","Select",""],["","71093012205","GABAPENTIN","CAP 400MG","90","Select","Select",""],["","24208031510","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","56151147002","TRUE","KIT METER","1","Select","Select",""],["","00006057761","JANUMET","TAB 50-1000","180","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":""}]}]}