{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ASERETEGDOH L ","gend":1,"add":" OP 9 TPA4212 XOB","city":"STAUNTON","state":"VA","zip":"24402-9998","dob":"1969-06-25","age":"","mstatus":"","insh":"4289110*60","cliId":"","pno":"44\/0458633-8","cno":"540\/448-3368","email":"","ename":"","eno":"","pphy":"SEATON, SCOTT M MD","ppno":"540\/942-1200","pcpadd":"1850 ROSSER AVE","pcpcity":"WAYNESBORO","pcpstate":"VA","pcpzip":22980,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"WESTERN\/ CHARLOTTESVILLE","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":["J32.0","J34.2","H65.31","Z68.29","J44.9","M25.571","R06.02","R60.0","J18.9","J44.1","Z87.891","R09.02","M93.871","M76.71","M19.071","Z87.730","F41.1","R32.","Z23.","J30.2","Z68.30","R79.89","Z12.31","Z12.11","Z11.59","K42.9","R22.43","M79.89","H61.21","Z01.419","M95.8","M67.89","J44.0","Z83.3","Z82.49","Z87.01","G47.00","Z76.89","K42.0","R63.5","N95.1","Z01.811","R06.83"],"date":["2020-01-27","2020-01-27","2020-11-30","2020-02-20","2020-06-16","2020-03-12","2021-06-23","2020-05-31","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2020-06-08","2020-06-08","2020-06-08","2020-02-24","2020-05-27","2020-05-27","2020-05-27","2022-05-03","2020-06-16","2020-05-27","2020-05-27","2020-05-27","2020-05-27","2022-06-15","2020-05-31","2020-06-02","2022-05-03","2022-08-04","2020-06-08","2020-06-08","2021-06-23","2021-06-23","2021-06-23","2021-06-23","2020-03-05","2021-06-22","2022-06-15","2020-01-17","2020-01-17","2020-06-16","2020-06-16"],"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":[]},{"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":[["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","00469260230","MYRBETRIQ","TAB 50MG","30","Select","Select",""],["","41100082073","MIRALAX","POW 3350 NF","238","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","57896022110","ACETAMIN","TAB 500MG","30","Select","Select",""],["","49281072210","FLUBLOK","INJ 2022-23","0","Select","Select",""],["","68382025701","OXYBUTYNIN","TAB 15MG ER","90","Select","Select",""],["","68462038730","SOLIFENACIN","TAB 10MG","90","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","10","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","00054418325","DEXAMETHASON","TAB 2MG","5","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","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":""}]}]}