{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ALEGNARELLEK","gend":1,"add":"CRO BARC 79224 TPA DR DRAH","city":"TAZEWELL","state":"VA","zip":"24651-9998","dob":"1981-07-06","age":"","mstatus":"","insh":"2038110*48","cliId":"","pno":"42\/6725790-5","cno":"","email":"","ename":"","eno":"","pphy":"RAMAKRISHNAN, KARTHIK MD","ppno":"276\/325-0417","pcpadd":"1761 PARK AVE SW","pcpcity":"NORTON","pcpstate":"VA","pcpzip":24273,"pcpcounty":"","pcpid":"","pcpname":"INFINITY MEDICAL MANAGEMENT","plan":"OHP","program":"MEDICAID","lob":"M4","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":["F11.20","F43.10","F32.9","F17.210","F12.10","F40.10","F32.0","F19.10","I10.","F33.2","F41.9","M25.511","R20.2","G89.29","Z86.39","Z83.3","Z83.42","M54.5","Z71.82","G47.00","M62.838","Z68.30","N39.0","B34.9","F32.2","J40.","J02.9","Z71.3","Z80.9","F32.1","F40.02","R07.89","Z68.29","K13.0"],"date":["2021-12-21","2020-06-30","2020-06-30","2021-03-09","2021-05-04","2021-12-21","2021-08-24","2021-10-19","2021-12-21","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-02-10","2020-01-13","2020-01-13","2020-02-10","2020-02-10","2020-12-15","2020-02-10","2020-02-10","2020-02-02","2019-03-14","2019-10-22","2019-09-24","2019-09-24","2019-12-03","2019-09-24","2019-10-02","2019-10-02","2019-08-28","2019-10-22","2019-12-03"],"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":{"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":[["","","SUBOXONE","MIS 8-2MG","","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","","BUPREN\/NALOX","MIS 8-2MG","","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","10","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","30","Select","Select",""],["","","BUPROPN","TAB 150MG XL","","Select","Select",""],["","","HYDROXYZ"," HYDROXYZ ","60","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","","ALL"," ALL ","10","Select","Select",""],["","","ACETAMINOPHE"," ACETAMINOPHE ","100","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","12","Select","Select",""],["","","FLUOXETINE"," FLUOXETINE ","30","Select","Select",""],["","","METOPROL"," METOPROL ","30","Select","Select",""],["","","HYDROCHLOROT"," HYDROCHLOROT ","30","Select","Select",""],["","","CLOTRIM\/BETA"," CLOTRIM\/BETA ","45","Select","Select",""],["","","GABAPENTIN","CAP 400MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","NICOTINE","LOZ 4MG MINT","","Select","Select",""],["","","SERTRALINE","TAB 50MG","","Select","Select",""],["","","ROPINIROLE","TAB 4MG ER","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","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":""}]}]}