{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A   YMROTSSABBA LA ","gend":1,"add":"EVOTSEW 236211 TPA EVA R","city":"ROANOKE","state":"VA","zip":"24015-9998","dob":"1993-06-15","age":"","mstatus":"","insh":"3262210*66","cliId":"","pno":"64\/0451037-7","cno":"","email":"","ename":"","eno":"","pphy":"NGUYEN, SON MD","ppno":"540\/772-3490","pcpadd":"2155 APPERSON DRIVE","pcpcity":"SALEM","pcpstate":"VA","pcpzip":24153,"pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z71.89","L70.9","L91.0","Z30.430","Z32.02","B37.3","L53.9","R21.","F32.1","N89.8","O80.","Z37.0","Z3A.00","O35.8XX0","Z3A.36","H04.123","H10.45","H52.13","H52.223","Z30.431","L23.9","L70.0","Z34.93","Z3A.40","M77.8","Z76.89","Z3A.39","Z01.419","Z97.5","N92.1","Z30.432","Z30.011","Z31.5","Z3A.32","F33.2","F41.1","Z39.1","Z34.82","Z34.83","O26.90","NO DATA","O48.0","Z23.","L29.9"],"date":["2020-01-10","2020-12-09","2021-07-07","2021-03-31","2021-03-31","2021-03-31","2021-06-07","2021-06-07","2021-10-05","2021-10-05","2021-02-19","2021-02-19","2021-02-19","2020-02-14","2020-02-14","2021-03-02","2021-03-02","2021-03-02","2021-03-02","2021-04-29","2021-07-07","2021-07-07","2020-03-16","2020-03-16","2020-10-02","2020-10-02","2021-02-19","2021-07-13","2021-07-13","2021-07-13","2021-08-24","2021-08-24","2020-01-16","2020-01-16","2021-09-04","2021-09-04","2020-01-31","2020-01-31","2020-11-24","2020-02-03","2021-12-13","2020-03-16","2020-11-24","2021-06-07"],"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":[["","00713022615","TRIAMCINOLON","CRE 0.00025","15","Select","Select",""],["","68462010340","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00527293437","PREDNISONE","TAB 20MG","15","Select","Select",""],["","","CLINDAMYCIN","GEL 0.01","","Select","Select",""],["","68180086673","BLISOVI","TAB 1.5\/30","28","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","30","Select","Select",""],["","00115180301","HYDROXYZ","CAP 25MG","15","Select","Select",""],["","00168014630","HYDROCORT","OIN 0.025","28","Select","Select",""],["","00472011745","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","00555902858","JUNEL","TAB 1.5\/30","28","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","13668000901","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","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":""}]}]}