{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"OSILLAAGAH N","gend":1,"add":"YRGNUH 936RD REHTOM ","city":"MARION","state":"VA","zip":"24354-9998","dob":"1990-07-26","age":"","mstatus":"","insh":"2166110*01","cliId":"","pno":"86\/6720841-5","cno":"","email":"","ename":"","eno":"","pphy":"JENNINGS, JENNIFER Q MD","ppno":"276\/783-8123","pcpadd":"1046 TERRACE DR","pcpcity":"MARION","pcpstate":"VA","pcpzip":"24354","pcpcounty":"","pcpid":"","pcpname":"ROYAL OAK MEDICAL ASSOCIATES PC","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":["B18.2","J01.00","F90.0","F31.32","F41.1","F17.200","Z68.26","R53.83","R52.","K73.2","Z79.899","R10.9","E87.6","N39.0","J30.1","F11.20","B19.20","Z68.24","F32.3","Z23.","R11.0","Z68.23","F90.9","F30.10","Z68.25","R50.9","R09.81","R63.0","R43.0","Z03.818","U07.1"],"date":["2021-08-10","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-05-07","2020-01-16","2020-01-16","2020-05-18","2020-07-08","2020-07-08","2020-07-08","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2020-12-15","2020-12-15","2020-12-15","2020-12-15","2020-09-14","2020-09-14","2020-09-14","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2021-05-07"],"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":[["","54092038701","ADDERALL","CAP 20MG","60","Select","Select",""],["","00054018913","BUPREN\/NALOX","SUB 8-2MG","13","Select","Select",""],["","00228306011","AMPHET\/DEXTR","CAP 20MG ER","60","Select","Select",""],["","00074262528","MAVYRET","TAB 100-40MG","84","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","5","Select","Select",""],["","70436001002","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","13668013701","ESCITALOPRAM","TAB 20MG","90","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":""}]}]}