{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NOSIDAMDAEHEROM L","gend":1,"add":"EDLIW 8164DAOR SSENR","city":"BLAND","state":"VA","zip":"24315-9998","dob":"2003-04-05","age":"","mstatus":"","insh":"4085110*75","cliId":"","pno":"79\/6726217-0","cno":"","email":"","ename":"","eno":"","pphy":"TURSKI, JOHN T DO","ppno":"276\/688-4331","pcpadd":"12301 GRAPEFIELD ROAD","pcpcity":"BASTIAN","pcpstate":"VA","pcpzip":24314,"pcpcounty":"","pcpid":"","pcpname":"BLAND COUNTY MEDICAL CLINIC INC","plan":"OHP","program":"MEDICAID","lob":"M4","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":["Z01.419","Z11.3","M54.2","Z68.53","Z71.9","Z71.3","M54.9","G89.29","N62.","R51.9","M54.6","L30.4","M25.519","Z30.42","Z20.822","Z20.828","NO DATA","K62.5","Z71.82","Z68.29","F32.1","R01.1","Z13.31","M25.529","N64.81","K21.9","Z83.79","R10.30","J02.9","H65.193","R09.81","F41.9","L60.0","Z00.129","N93.9"],"date":["2020-11-09","2020-11-09","2021-09-01","2021-03-12","2021-07-13","2021-12-07","2021-09-01","2021-05-14","2021-09-01","2021-05-25","2021-05-25","2021-05-25","2021-05-25","2021-02-09","2021-08-12","2021-08-22","2021-12-07","2021-12-21","2021-12-07","2021-12-07","2021-07-13","2021-07-13","2021-07-13","2021-09-01","2021-09-01","2021-12-21","2021-12-21","2021-12-21","2021-08-22","2020-10-19","2020-10-19","2021-06-08","2021-07-24","2020-02-25","2020-08-29"],"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":[["","","LORYNA","TAB 3-0.02MG","","Select","Select",""],["","66993037179","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","","VIENVA","TAB 0.1-20","","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","364","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","12","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","FLUTICASONE","SPR 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":""}]}]}