{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YHTOMITTNAYRB R ","gend":0,"add":"EDNA 7271YWH NOSR","city":"CUMBERLAND","state":"VA","zip":"23040-9998","dob":"1964-10-30","age":"","mstatus":"","insh":"40500210*37","cliId":"","pno":"64\/4087820-7","cno":"","email":"","ename":"","eno":"","pphy":"BASHORE, RANDALL T MD","ppno":"434\/581-3271","pcpadd":"RT 15 SOUTH","pcpcity":"NEW CANTON","pcpstate":"VA","pcpzip":23123,"pcpcounty":"","pcpid":"","pcpname":"CENTRAL VIRGINIA HEALTH SERVICES INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["E11.9","E11.65","B35.1","I73.89","M79.674","M20.42","M20.41","R60.0","Z71.89","Z71.3","H40.003","Z79.4","Z23.","M79.675","E11.42","H47.292","Z96.1","H52.4"],"date":["2021-09-03","2022-06-15","2022-11-03","2022-11-03","2022-11-03","2022-11-03","2022-11-03","2022-11-03","2020-02-18","2020-02-18","2021-03-16","2021-03-16","2021-03-17","2022-02-10","2022-02-10","2022-06-15","2022-06-15","2022-06-15"],"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":[["","68382075810","METFORMIN","TAB 500MG","360","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","71093011105","GABAPENTIN","TAB 600MG","270","Select","Select",""],["","68180046803","LOVASTATIN","TAB 20MG","90","Select","Select",""],["","00173071820","FLOVENT","AER 44MCG","11","Select","Select",""],["","00002771227","HUMALOG","INJ 200\/ML","18","Select","Select",""],["","65862020299","LOSARTAN","TAB 50MG","30","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","180","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","60","Select","Select",""],["","00093729505","CARVEDILOL","TAB 12.5MG","180","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","68382012205","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","62175013643","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","34","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","8","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","90","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","12","Select","Select",""],["","57513000628","PEN  NEEDLES","MIS 31GX6MM","30","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","20","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","51660033301","ARTHRTS","TAB 650MG","20","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","34","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","27","Select","Select",""],["","86227013055","SURE","MIS 32GX6MM","120","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","15","Select","Select",""],["","68462034690","LEVOCETIRIZI","TAB 5MG","90","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":""}]}]}