{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ELOHCINSNILLUM","gend":1,"add":"OB OP124 X","city":"NORTON","state":"VA","zip":"24273-9998","dob":"1978-04-04","age":"","mstatus":"","insh":"4382210*84","cliId":"","pno":"78\/6724211-0","cno":"","email":"","ename":"","eno":"","pphy":"NIDA, MAURICE E DO","ppno":"276\/679-0321","pcpadd":"295 WHARTON LN","pcpcity":"NORTON","pcpstate":"VA","pcpzip":24273,"pcpcounty":"","pcpid":"","pcpname":"WELLMONT MEDICAL ASSOCIATES 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":["R07.9","K27.9","K21.9","I10.","R07.2","K26.9","K29.70","S93.491A","Z01.818","Z20.822","G43.709","C56.9","M79.604","Z01.419","Z12.31","R10.32","Z28.21","F17.200","Z68.28","N95.1","Z20.828","M25.571","S99.911A","M54.9","V58.89","M54.5","Z00.00","R12.","F41.9","G43.719","F51.01","F32.9","N39.0","E86.0","E83.52","Z11.59","R06.00","R11.2","E83.42","Z80.0","K25.3","K29.60","J32.9","J30.9","R10.9","K59.00","R09.82","J34.3","J30.1","L23.7"],"date":["2022-01-09","2021-03-30","2021-03-16","2021-02-23","2021-03-06","2021-03-16","2021-03-30","2020-05-29","2021-03-10","2021-03-10","2022-01-05","2020-12-13","2020-12-13","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-14","2021-01-18","2020-05-22","2020-05-22","2020-12-22","2020-05-26","2020-05-26","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-10-13","2020-12-12","2020-12-13","2020-12-13","2020-12-12","2020-12-13","2021-01-12","2020-12-13","2021-01-19","2021-01-19","2021-01-19","2021-03-17","2021-03-17","2021-01-12","2021-01-12","2021-03-29","2021-03-29","2021-03-29","2022-07-08"],"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":[["","","GABAPENTIN","TAB 600MG","","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","69842026805","CVS","SOL 0.001","5","Select","Select",""],["","51991081403","AZELASTINE","SPR 0.001","30","Select","Select",""],["","","SUCRALFATE","TAB 1GM","","Select","Select",""],["","70069000701","OLOPATADINE","DRO 0.001","5","Select","Select",""],["","","UBRELVY","TAB 100MG","","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","2","Select","Select",""],["","","NICOTINE","DIS 14MG\/24H","","Select","Select",""],["","","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","56","Select","Select",""],["","00527193206","CLARITHROMYC","TAB 500MG","28","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","PHENAZOPYRID","TAB 100MG","","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 7.5MG","","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":""}]}]}