{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M NOSAJERIUGC","gend":0,"add":"VOD 63TS RE","city":"STAUNTON","state":"VA","zip":"24401-9998","dob":"1978-01-08","age":"","mstatus":"","insh":"2382210*87","cliId":"","pno":"64\/0454090-6","cno":"540\/466-0904","email":"","ename":"","eno":"","pphy":"ARTEAGA, ASHLEE S MD","ppno":"540\/885-3525","pcpadd":"40 LAMBERT ST SUITE 522","pcpcity":"STAUNTON","pcpstate":"VA","pcpzip":24401,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","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":["G81.01","R47.01","Z86.73","Z99.89","S22.42XA","F19.10","W11.XXXA","S42.211A","S02.19XA","S01.81XA","S02.92XA","S42.201A","M25.511","G89.18","S06.0X9A","S02.82XA","S42.252A","S01.511A","S02.2XXA","S01.21XA","S02.5XXA","F17.210","Z20.828","Z23."],"date":["2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-23","2020-11-23","2020-11-23","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-23","2020-11-23","2020-11-23","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22","2020-11-22"],"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":[["","10702000610","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","52817019610","TRAMADOL","TAB 100MG","20","Select","Select",""],["","42571016201","AMOX\/K","TAB 875-125","6","Select","Select",""],["","00904645780","DOK","CAP 100MG","30","Select","Select",""],["","70000044701","SENNA","TAB 8.6MG","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","30","Select","Select",""],["","67877031905","IBUPROFEN","TAB 400MG","30","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":""}]}]}