{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A   YLIMECITEKUL ","gend":1,"add":"LA 2013RD ECI","city":"BLACKSBURG","state":"VA","zip":"24060-9998","dob":"1992-09-25","age":"","mstatus":"","insh":"16600210*05","cliId":"","pno":"55\/0456741-3","cno":"540\/553-1476","email":"","ename":"","eno":"","pphy":"LOIS, HILARY DO","ppno":"540\/951-1111","pcpadd":"SUITE A 3700 S MAIN ST","pcpcity":"BLACKSBURG","pcpstate":"VA","pcpzip":24060,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["F33.9","F41.9","F41.8","J02.9","J03.01","J35.1","H69.81","R49.0","M25.512","V58.89","R06.83","J03.90","N93.9","Z97.5","S46.912A","W22.8XXA","Z20.828","R60.0","Z68.41","M25.572","S69.92XA","S62.657A","S43.422A"],"date":["2020-08-11","2020-08-11","2021-10-14","2021-01-21","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-12-23","2021-12-01","2021-02-24","2021-04-16","2020-05-05","2020-05-05","2021-10-17","2021-10-17","2021-02-04","2020-06-29","2020-06-29","2020-06-29","2020-07-02","2020-07-02","2021-10-20"],"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":[["","65862019399","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","68180051202","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","70436001006","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","60006019166","ON\/GO","KIT ANTIGEN","4","Select","Select",""],["","00121092716","PROMETHAZINE","SOL 6.25\/5ML","280","Select","Select",""],["","65162067684","AZELASTINE","SPR 0.001","30","Select","Select",""],["","00143211250","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","20","Select","Select",""],["","64980044801","NEO\/POLY\/HC","SUS 1% OTIC","10","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","00527217037","DICLOFENAC","TAB 100MG ER","30","Select","Select",""],["","00527600274","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","59762015502","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","2","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","40","Select","Select",""],["","00527293341","PREDNISONE","TAB 10MG","11","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","14","Select","Select",""],["","23155013525","DOXYCYC","TAB 100MG","14","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","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":""}]}]}