{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YNOHTNALLENSOG R","gend":0,"add":"REVOTSEW 28212TPA2 TPA RD ","city":"COLLINSVILLE","state":"VA","zip":"24078-9998","dob":"1989-07-27","age":"","mstatus":"","insh":"24100210*69","cliId":"","pno":"15\/5758511-3","cno":"","email":"","ename":"","eno":"","pphy":"NKEMBE, KWAMBA EKWA MD","ppno":"276\/956-2233","pcpadd":"4944 GREENSBORO ROAD","pcpcity":"RIDGEWAY","pcpstate":"VA","pcpzip":24148,"pcpcounty":"","pcpid":"","pcpname":"MARTINSVILLE HENRY COUNTY COALITION FOR HEALTH AND WELLNESS","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":["F25.0","S46.812A","F20.9","Z88.8","F17.210","M25.512","S46.912A","S80.211A","M25.521","R68.89","F16.10","H92.01","J06.9","J20.9","M26.601","Z71.6","F31.9","Z98.890","M26.621","J42.","F32.9","V62.84","F32.2"],"date":["2020-05-20","2020-02-16","2020-02-16","2020-02-16","2020-02-16","2020-02-16","2020-02-16","2020-08-17","2020-08-18","2019-10-16","2019-10-17","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-06-24","2019-10-16","2019-10-16","2019-10-21"],"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":{"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":[["","","NAPROXEN","TAB 550MG","","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","45802057178","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","00904530680","BANOPHEN","CAP 25MG","90","Select","Select",""],["","63736012002","NIX","LIQ 0.01","59","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":""}]}]}