{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  LEAHCIMHTIMS L ","gend":0,"add":"OB OP715 X","city":"DUBLIN","state":"VA","zip":"24084-9998","dob":"1961-09-25","age":"","mstatus":"","insh":"4222210*78","cliId":"","pno":"02\/0452223-5","cno":"","email":"","ename":"","eno":"","pphy":"KING-MALLORY, REBECCA MD","ppno":"540\/585-1310","pcpadd":"5826 RUEBUSH ROAD","pcpcity":"DUBLIN","pcpstate":"VA","pcpzip":24084,"pcpcounty":"","pcpid":"","pcpname":"FREE CLINIC OF THE NEW RIVER VALLEY INC","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","R74.0","M77.31","E03.9","G47.33","E78.2","Z13.31","Z01.810","M20.21","M20.11","E78.5","Z48.89","H17.11","L60.0","M79.642","H16.011","NO DATA","Z01.00","Z01.818","Z20.822","R73.03","K76.0","Z23.","I25.10","T14.8XXA","R10.9","M62.830","Z71.89","M46.1","S05.01XA","X58.XXXA","M79.671","R06.83","R06.81","R53.83","K21.9","N52.03","E88.81","I34.0","Z98.61","Z11.52","M20.12","M20.22","M19.071","Z12.11","D12.3","K62.1","K57.30","M79.89","K63.5","E74.39","G47.9","R21.","H10.45"],"date":["2022-04-20","2020-03-19","2020-03-19","2022-03-09","2021-02-06","2022-03-09","2022-03-09","2020-09-09","2020-09-17","2020-09-17","2020-09-17","2020-10-02","2021-03-04","2021-09-20","2021-09-22","2020-03-06","2020-02-28","2020-02-28","2020-09-12","2022-04-24","2020-10-03","2022-03-09","2022-03-09","2022-03-09","2021-09-20","2021-03-01","2021-03-01","2021-03-01","2021-03-08","2020-02-28","2020-02-28","2020-03-09","2020-05-26","2020-05-26","2020-05-26","2022-03-09","2020-05-26","2020-05-26","2020-05-26","2020-05-26","2021-04-08","2021-03-29","2021-03-29","2019-12-02","2019-10-14","2019-10-14","2019-10-14","2019-10-14","2019-12-02","2019-10-14","2022-03-09","2022-03-09","2022-03-09","2022-11-02"],"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":[["","59779060027","CVS","TAB 81MG EC","90","Select","Select",""],["","59651017301","DOXEPIN","CAP 10MG","30","Select","Select",""],["","00310628030","XIGDUO","TAB 10-1000","90","Select","Select",""],["","55111078401","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","55111019605","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","LOSARTAN\/HCT","TAB 50-12.5","","Select","Select",""],["","","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","69238183107","LEVOTHYROXIN","TAB 50MCG","30","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","68382009505","CARVEDILOL","TAB 25MG","60","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","49483048112","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","","SILDENAFIL","TAB 100MG","","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","16729008110","NALTREXONE","TAB 50MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","16729022501","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","68180046509","SIMVASTATIN","TAB 80MG","30","Select","Select",""],["","","LOSARTAN","TAB 50MG","","Select","Select",""],["","","MOXIFLOXACIN","SOL HCL 0.5%","","Select","Select",""],["","","TOBRAMYCIN","SOL 0.3% OP","","Select","Select",""],["","","POLYMYXIN","SOL TRIMETHP","","Select","Select",""],["","","PREDNISOLONE","SUS 1% OP","","Select","Select",""],["","","PNEUMOVAX","INJ 25\/0.5","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","","AMOXICILLIN","TAB 500MG","","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","NARCAN","SPR ","","Select","Select",""],["","49281071910","FLUBLOK","INJ 2019-20","0","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","10","Select","Select",""],["","31722071290","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","10","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":""}]}]}