{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NAYRBSIWEL P","gend":0,"add":"ACYS 428EVA EROM","city":"BUENA VISTA","state":"VA","zip":"24416-9998","dob":"1967-02-13","age":"","mstatus":"","insh":"22500210*14","cliId":"","pno":"62\/0450218-1","cno":"540\/261-8120","email":"","ename":"","eno":"","pphy":"HAMILTON, THOMAS FRANCIS MD","ppno":"540\/261-7421","pcpadd":"2252 MAGNOLIA AVE","pcpcity":"BUENA VISTA","pcpstate":"VA","pcpzip":24416,"pcpcounty":"","pcpid":"","pcpname":"","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":["F33.1","F41.8","M47.812","F17.210","F10.10","H57.12","H11.32","E78.2","Z79.899","Z23.","Z00.00","I80.01","D64.9","M54.31"],"date":["2022-10-18","2022-09-21","2021-03-18","2020-12-16","2022-09-09","2021-02-02","2021-02-02","2022-09-21","2022-03-21","2022-09-21","2021-12-21","2021-06-23","2021-12-21","2022-09-21"],"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":[["","68462019690","PRAVASTATIN","TAB 20MG","90","Select","Select",""],["","68180047903","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","51991070505","ALPRAZOLAM","TAB 0.5MG","60","Select","Select",""],["","51991074810","DULOXETINE","CAP 60MG","30","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","13668001105","CITALOPRAM","TAB 40MG","30","Select","Select",""],["","80681004000","MELATONIN","TAB 5MG","30","Select","Select",""],["","70710122701","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","00115180401","HYDROXYZ","CAP 50MG","90","Select","Select",""],["","42806066301","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","14","Select","Select",""],["","42571025201","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","29300022601","METRONIDAZOL","TAB 250MG","21","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":""}]}]}