{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"V   NIVEKREDWORB ","gend":0,"add":"REPSIHW 122NL ENIP GNI","city":"HILLSVILLE","state":"VA","zip":"24343-9998","dob":"1977-10-18","age":"","mstatus":"","insh":"40500210*32","cliId":"","pno":"27\/6720533-8","cno":"","email":"","ename":"","eno":"","pphy":"OSBORNE, PATRICIA G NP","ppno":"276\/728-4311","pcpadd":"702 PINE STREET","pcpcity":"HILLSVILLE","pcpstate":"VA","pcpzip":24343,"pcpcounty":"","pcpid":"","pcpname":"DLP TWIN COUNTY PHYSICIAN PRACTICES LLC","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":["R07.9","R20.0","M65.871","G57.61","M79.671","Z23.","M62.81","R19.7","R53.83","F41.9","G40.319","R41.3","M54.32","R00.8","F41.0","R07.89","R06.02","R00.2","E78.5","F17.210","Z79.899","F41.1","Z00.01","E78.2","G40.909","R63.4","Z74.3","R94.6","E55.9","R63.1","M54.5","R11.2","E87.6","K52.9","R41.82","F15.10"],"date":["2021-12-23","2019-12-08","2020-08-27","2020-08-27","2020-08-27","2021-11-01","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2020-02-14","2020-02-14","2020-02-14","2021-10-08","2021-11-01","2021-12-07","2021-12-07","2021-12-01","2021-12-07","2021-12-07","2021-12-23","2019-12-08","2021-11-01","2021-11-01","2020-02-14","2021-09-09","2019-06-28","2020-04-13","2020-04-13","2020-04-13","2021-05-20","2021-07-24","2021-07-24","2021-07-24","2019-06-28","2019-06-28"],"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":[["","","PREGABALIN"," PREGABALIN ","60","Select","Select",""],["","50458064265","TOPAMAX","TAB 200MG","60","Select","Select",""],["","","TOPIRAMATE"," TOPIRAMATE ","120","Select","Select",""],["","","LOVASTATIN"," LOVASTATIN ","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","00228202750","ALPRAZOLAM","TAB 0.25MG","10","Select","Select",""],["","","ROSUVASTATIN","TAB 10MG","","Select","Select",""],["","00071101668","LYRICA","CAP 150MG","60","Select","Select",""],["","","DICLOFENAC","TAB 75MG DR","","Select","Select",""],["","","VITAMIN","CAP 50MCG","","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":""}]}]}