{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NYLORACREKEORB D","gend":1,"add":"I GOH 0923DAOR DNALS","city":"SURRY","state":"VA","zip":"23883-9998","dob":"1974-04-01","age":"","mstatus":"","insh":"2922610*89","cliId":"","pno":"07\/7576280-5","cno":"","email":"","ename":"","eno":"","pphy":"STEVENSON, MICHAEL G PA","ppno":"757\/357-3331","pcpadd":"201 GUMWOOD DRIVE","pcpcity":"SMITHFIELD","pcpstate":"VA","pcpzip":23430,"pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICAL CARE OF SMITHFIELD PLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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":["F11.20","Z23.","E03.8","M79.7","Z68.36","N81.6","Z00.00","Z13.89","E78.5","K21.9","M54.5","R73.03","M54.16","Z01.419","Z71.3","Z68.35","Z68.33","F41.1","K21.0","R21.","G47.00","F32.9","Z68.37","N81.3","E03.9","E66.9","R14.0","N94.5","Z12.11","E11.9","N80.0","Z68.34","R42."],"date":["2022-11-15","2021-12-06","2022-02-10","2021-05-04","2022-11-02","2021-11-30","2021-08-10","2021-08-10","2022-02-10","2021-08-10","2021-08-10","2021-08-10","2021-11-19","2021-12-14","2020-08-14","2022-04-14","2020-07-29","2021-12-06","2020-07-29","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2022-04-14","2022-04-14","2022-04-14","2022-01-04","2022-01-04","2022-06-28","2022-05-13","2022-04-14","2022-05-13","2022-11-02"],"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":[["","62332014360","CELECOXIB","CAP 400MG","1","Select","Select",""],["","00378180510","LEVOTHYROXIN","TAB 75MCG","90","Select","Select",""],["","00046110281","PREMARIN","TAB 0.625MG","30","Select","Select",""],["","33342032715","TRIAMCINOLON","CRE 0.00025","15","Select","Select",""],["","","FENOFIBRATE","TAB 48MG","","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","9","Select","Select",""],["","00046110811","PREMPRO","TAB 0.625-5","28","Select","Select",""],["","","OMEPRAZOLE","TAB 20MG","","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","","GABAPENTIN","TAB 800MG","","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","90","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","6","Select","Select",""],["","","ATORVASTATIN","TAB 10MG","","Select","Select",""],["","00093026215","FLUOCINONIDE","CRE 0.0005","15","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","15","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","9","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","28","Select","Select",""],["","65162083614","ACYCLOVIR","CRE 0.05","5","Select","Select",""],["","00378064010","PREDNISONE","TAB 5MG","23","Select","Select",""],["","","ALLI","CAP 60MG","","Select","Select",""],["","","PANTOPRAZOLE","TAB 20MG","","Select","Select",""],["","","SAXENDA","INJ 18MG\/3ML","","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":""}]}]}