{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A   TTOCSRJ ETIHW ","gend":0,"add":"OH TRUOC 253C TPA RD ESU","city":"SALUDA","state":"VA","zip":"23149-9998","dob":"2002-06-29","age":"","mstatus":"","insh":"4258110*33","cliId":"","pno":"58\/4082443-4","cno":"","email":"","ename":"","eno":"","pphy":"RANSONE, KAREN A MD","ppno":"804\/776-8000","pcpadd":"16681 GENERAL PULLER HIGHWAY","pcpcity":"DELTAVILLE","pcpstate":"VA","pcpzip":23043,"pcpcounty":"","pcpid":"","pcpname":"Riverside Fishing Bay Family Practice","plan":"OHP","program":"MEDICAID","lob":"M4","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","Z79.4","E66.01","Z68.54","J02.0","E11.65","R53.83","Z79.84","L83.","E66.9","E78.5","F41.9","J02.9","R73.9","J45.909","F84.5","Z83.3","A08.4","R07.89"],"date":["2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-01-14","2020-01-23","2020-01-14","2020-01-23","2020-01-14","2020-04-20","2020-04-20","2021-07-21","2019-11-19","2019-11-20","2019-04-17","2019-04-17","2019-04-17","2019-10-11","2019-04-16"],"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":[["","68382013814","TOPIRAMATE","TAB 25MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","","GLIMEPIRIDE","TAB 1MG","","Select","Select",""],["","23155010210","METFORMIN","TAB 500MG","60","Select","Select",""],["","53885065701","ONETOUCH","KIT VERIO","1","Select","Select",""],["","","LANTUS","INJ 100\/ML","","Select","Select",""],["","","UNFINE","MIS 32GX4MM","","Select","Select",""],["","56151146004","TRUE","TES GLUCOSE","100","Select","Select",""],["","","GLUCAGON","KIT 1MG","","Select","Select",""],["","","NOVOLOG","INJ FLEXPEN","","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","20","Select","Select",""],["","70000040701","ANTISEPTIC","SOL 0.04","237","Select","Select",""],["","99073070914","FREESTYLE    KIT FREEDOM","KIT FREEDOM","1","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","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":""}]}]}