{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   DIVADSKOORB A","gend":0,"add":"NIK 506YWH SG","city":"FREDERICKSBURG","state":"VA","zip":"22405-9998","dob":"1973-03-15","age":"","mstatus":"","insh":"4402210*80","cliId":"","pno":"46\/0450007-2","cno":"540\/642-7000","email":"","ename":"","eno":"","pphy":"GUPTA, VIKAS MD","ppno":"540\/656-2800","pcpadd":"912 LAFAYETTE BLVD","pcpcity":"FREDERICKSBURG","pcpstate":"VA","pcpzip":22401,"pcpcounty":"","pcpid":"","pcpname":"","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":["Z20.828","F11.20","B34.9","R09.81","Z20.822","F20.9","F11.21","L03.114","L02.414","F32.9","V62.84","F10.150","F10.920","Z63.8","F19.90","F17.210","M79.603","R06.2","F15.20","F41.9","F10.120","Z04.6","M79.641","S63.501A","X58.XXXA"],"date":["2021-04-04","2022-10-20","2022-03-28","2022-03-28","2022-03-28","2022-09-22","2022-09-22","2022-09-30","2022-09-30","2021-08-01","2020-01-07","2020-01-07","2020-01-07","2020-01-07","2022-03-28","2022-09-30","2022-09-30","2020-01-08","2021-08-01","2021-08-01","2020-01-06","2020-01-06","2021-08-01","2021-08-01","2021-08-01"],"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":[["","47781035703","BUPREN\/NALOX","MIS 8-2MG","14","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","14","Select","Select",""],["","00093216568","NALOXONE","SPR 4MG","2","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","7","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","14","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","70436005801","BUPROPION","TAB 100MG SR","30","Select","Select",""],["","13668021730","ARIPIPRAZOLE","TAB 5MG","14","Select","Select",""],["","70436001002","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","59651036105","IBUPROFEN","TAB 600MG","90","Select","Select",""],["","60505006501","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00378113401","KETOROLAC","TAB 10MG","14","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","43547034006","RISPERIDONE","TAB 0.5MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","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":""}]}]}