{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" E   DLANORRJ RENTTIB","gend":0,"add":"ORRAH 03351DAOR ETAGW","city":"CHESTER","state":"VA","zip":"23831-9998","dob":"1965-11-01","age":"","mstatus":"","insh":"4785110*95","cliId":"","pno":"52\/4080475-5","cno":"804\/605-8457","email":"","ename":"","eno":"","pphy":"ROSE, ANDREW MD","ppno":"804\/717-5300","pcpadd":"SUITE 117 16011 IRONBRIDGE ROAD","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":23831,"pcpcounty":"","pcpid":"","pcpname":"IRONBRIDGE 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":["M75.122","R29.898","R51.9","Z68.39","T63.301A","L08.9","M67.912","E66.01","M75.102","G89.18","R03.0","R35.1","Z12.5","Z12.11","Z80.0","Z68.41","D12.5","J18.9","T63.391A","M25.512","I65.23","B35.4","R47.89","R56.9","D12.0","D12.2","D12.3","R00.1","I10.","G25.81","R07.81","R20.0","K81.9","L02.423","L02.424","L02.223","L29.8","L20.89","T14.8XXA","D22.5","L81.8","M70.71","L97.519","R74.01","R21.","R10.811","Z79.899","F17.210","R11.0","K81.1"],"date":["2020-04-28","2020-01-22","2021-01-26","2021-01-26","2021-04-27","2022-03-03","2019-10-22","2020-10-12","2019-11-08","2019-11-08","2020-12-02","2019-10-22","2019-10-22","2019-10-29","2019-10-22","2020-02-27","2019-10-29","2020-03-10","2021-04-27","2019-09-10","2021-01-06","2019-07-11","2021-01-06","2021-01-06","2019-10-29","2019-10-29","2019-10-29","2020-02-05","2022-08-28","2020-12-02","2020-02-05","2020-12-17","2022-09-16","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-03-30","2022-08-28","2022-08-28","2022-01-24","2022-08-28","2022-08-28","2022-08-28","2022-08-28","2022-09-16"],"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":[["","21922002107","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","","CETIRIZINE","TAB 10MG","","Select","Select",""],["","00603533815","PREDNISONE","PAK 10MG","21","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","60","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","60","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","59779045888","ALLERGY","TAB 10MG","30","Select","Select",""],["","","AMITRIPTYLIN","TAB 25MG","","Select","Select",""],["","","LISINOPRIL","TAB 5MG","","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","","ROPINIROLE","TAB 0.25MG","","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","","ALBUTEROL","NEB 0.00083","","Select","Select",""],["","","LEVOFLOXACIN","TAB 500MG","","Select","Select",""],["","","HYD","SUS 10-8\/5ML","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","","BUT\/APAP\/CAF","TAB ","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","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":""}]}]}