{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"T ARUALECNERRO","gend":1,"add":"IRG DLO 0263DAOR LLIM TS","city":"APPOMATTOX","state":"VA","zip":"24522-9998","dob":"1984-10-08","age":"","mstatus":"","insh":"4691110*80","cliId":"","pno":"05\/4346143-9","cno":"434\/509-3416","email":"","ename":"","eno":"","pphy":"BARKLEY, DEBORAH NP","ppno":"434\/200-7210","pcpadd":"16890 FOREST ROAD","pcpcity":"FOREST","pcpstate":"VA","pcpzip":24551,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","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":["Q61.2","F32.0","F15.20","Z20.828","N39.0","N20.0","A41.9","Z72.0","N12.","Q61.3","R39.9","F15.21","E87.1","D50.9","N92.0","G43.909","F15.10","Z20.822","K04.7","F41.9","Z71.3","Z71.82","F17.210","S62.615A","Y04.0XXA","M20.022","R10.9","Z16.29","B96.20","E86.1","Z82.71","J02.0","N76.0","M79.645","N10.","D64.9","J02.9","N92.5","Z01.411","N84.0","N93.8","R10.31","R11.0","R39.12","N93.9"],"date":["2020-01-27","2020-05-11","2020-10-14","2020-11-13","2022-01-26","2022-06-24","2020-01-22","2022-06-24","2022-06-24","2022-06-24","2020-01-20","2020-01-22","2020-01-22","2022-06-24","2022-09-29","2021-04-08","2022-06-24","2022-08-23","2020-03-10","2020-03-10","2020-03-10","2020-03-10","2022-06-23","2021-10-07","2021-10-07","2021-10-28","2022-06-23","2020-01-19","2020-01-19","2020-01-19","2020-01-19","2020-03-21","2021-06-08","2021-10-28","2022-06-22","2022-06-22","2022-01-26","2022-03-28","2020-05-19","2022-05-18","2022-10-19","2022-06-22","2022-06-22","2022-06-22","2022-05-18"],"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":[["","68180071160","CEFDINIR","CAP 300MG","18","Select","Select",""],["","31722070430","VALACYCLOVIR","TAB 500MG","90","Select","Select",""],["","00245010810","FERROUS","TAB 325MG EC","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","6","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","6","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","9","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","10","Select","Select",""],["","68462030450","NORETHIN","TAB 5MG","60","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","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":""}]}]}