{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"T   YELSEWNOSIRRAH ","gend":0,"add":"LMURB 85332DAOR PAG YE","city":"ABINGDON","state":"VA","zip":"24210-9998","dob":"1989-04-22","age":"","mstatus":"","insh":"35500210*29","cliId":"","pno":"67\/6728359-2","cno":"276\/762-9538","email":"","ename":"","eno":"","pphy":"OWENS, DIA P MD","ppno":"276\/597-7081","pcpadd":"1721 LOVERS GAP ROAD","pcpcity":"VANSANT","pcpstate":"VA","pcpzip":24656,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["Z13.89","R10.11","Z72.0","J20.9","K44.9","R11.2","F41.1","F33.1","V62.89","Z62.810","F17.200","Z13.9","Z00.8","Z79.899","H69.83","H65.193","H92.03","J30.1","Z09.","R13.10","N20.2","N28.1","Z01.818","J01.90","Z20.822","N20.0","J06.9","Z11.59","J40.","K21.9","F17.210","J02.9","D51.9","J01.00","K52.9","R30.0","N34.2","R13.11","R05.","K22.2"],"date":["2020-11-20","2020-11-20","2020-11-30","2020-11-02","2020-11-02","2020-11-02","2020-05-14","2020-05-14","2020-01-07","2020-01-07","2020-11-20","2020-11-20","2020-11-20","2021-11-29","2020-03-13","2020-02-21","2020-02-21","2020-03-13","2020-11-20","2021-04-19","2020-11-20","2021-02-01","2021-04-13","2021-11-29","2021-02-03","2021-03-16","2020-11-30","2020-11-30","2021-11-29","2021-11-29","2021-11-29","2021-11-29","2020-03-20","2020-10-13","2020-10-29","2021-03-16","2021-03-16","2021-03-11","2020-11-28","2021-04-19"],"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":[["","51525029403","AZELASTINE","SPR 0.001","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00781223431","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","37205024897","VITAMIN","TAB 1000UNIT","60","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","65162011550","HYDROCO\/APAP","TAB 7.5-325","10","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","00173087310","INCRUSE","INH 62.5MCG","30","Select","Select",""],["","29300034905","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","50458057760","XARELTO","TAB 2.5MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","07610015540","MELATONIN","TAB 5MG","90","Select","Select",""],["","13668001990","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","51660052601","ALLERGY","TAB 10MG","30","Select","Select",""],["","51224001060","BENZONATATE","CAP 100MG","21","Select","Select",""],["","64380080308","RANITIDINE","TAB 150MG","30","Select","Select",""],["","61314064610","NEO\/POLY\/HC","SOL 1% OTIC","10","Select","Select",""],["","00093227534","AMOX\/K","TAB 875-125","20","Select","Select",""],["","45802043262","PSEUDOEPHEDR","TAB 30MG","24","Select","Select",""],["","60432027516","BROM\/PSE\/DM","SYP ","473","Select","Select",""],["","96295012323","D3","CAP 1000UNIT","60","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00527128201","DICYCLOMINE","TAB 20MG","11","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","58914001310","BENTYL","TAB 20MG","11","Select","Select",""],["","29033000305","SUCRALFATE","TAB 1GM","14","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00172572870","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","65162063609","PANTOPRAZOLE","TAB 20MG","20","Select","Select",""],["","37205098869","NICOTINE","LOZ 4MG MINT","162","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","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":""}]}]}