{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AINEDNACSRETAW ","gend":1,"add":"ACIRRUH DLO 62751 TOL EN DR EN","city":"WISE","state":"VA","zip":"24293-9998","dob":"1981-06-24","age":"","mstatus":"","insh":"2488110*08","cliId":"","pno":"23\/6721577-1","cno":"","email":"","ename":"","eno":"","pphy":"RUMLEY, WENDY N NP","ppno":"276\/679-5880","pcpadd":"601 COMMONWEALTHR","pcpcity":"NORTON","pcpstate":"VA","pcpzip":24273,"pcpcounty":"","pcpid":"","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","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":["J10.1","R50.9","Z79.899","M79.641","B07.0","M79.671","R68.89","H66.93","R11.0","F32.89","M54.32","B37.3","R11.2","Z03.818","R19.7","F41.9","K21.9","M79.674","J30.1","M25.511","M75.21","L73.2","F32.9","E55.9","E78.2","Z13.9","G25.81","M54.16","G89.29","Z20.822","U07.1","J02.9","R05.","R06.02","K29.80","R10.13","R19.5","E66.01","J32.9","B96.89","H65.02","J30.2","R14.0","K22.70","D73.89","R10.31","J40.","K52.9","K29.70","K29.90","K22.8","NO DATA","G62.9","R51.","L21.9"],"date":["2020-01-14","2021-03-29","2020-03-30","2020-09-16","2020-12-29","2020-12-29","2021-03-03","2021-03-03","2021-03-03","2021-02-01","2021-02-01","2021-02-01","2021-10-18","2021-10-18","2021-10-18","2021-08-04","2021-08-04","2020-12-03","2020-12-03","2021-08-04","2021-08-04","2021-08-04","2021-08-04","2020-03-30","2020-03-30","2020-03-30","2020-03-30","2020-03-30","2020-03-30","2021-10-18","2021-03-29","2021-03-29","2021-03-29","2019-02-22","2019-04-04","2019-05-03","2019-03-08","2019-11-12","2019-11-12","2019-11-12","2019-07-23","2019-07-23","2019-01-31","2019-05-03","2019-01-30","2019-01-30","2019-03-04","2019-03-04","2019-04-04","2019-04-04","2019-04-04","2019-10-02","2019-10-02","2019-10-02","2019-10-02"],"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":[["","00378140496","RIZATRIPTAN","TAB 10MG","12","Select","Select",""],["","43547027150","ROPINIROLE","TAB 2MG","30","Select","Select",""],["","00378116580","BUSPIRONE","TAB 15MG","90","Select","Select",""],["","62175013637","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","00378395105","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","68180059206","DESVENLAFAX","TAB 50MG ER","30","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","30","Select","Select",""],["","10370010103","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","65862052899","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00603533932","PREDNISONE","TAB 20MG","6","Select","Select",""],["","59762372802","CLINDAMYCIN","SOL 0.01","60","Select","Select",""],["","00234057516","HIBICLENS","LIQ 0.04","120","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","52380127208","CHLOR","LIQ 0.04","120","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","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":""}]}]}