{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"W   IROLNEDACM ","gend":1,"add":"COL 971TS TSU","city":"BRACEY","state":"VA","zip":"23919-9998","dob":"1979-07-02","age":"","mstatus":"","insh":"4955110*92","cliId":"","pno":"29\/4082427-6","cno":"","email":"","ename":"","eno":"","pphy":"ALI, AHMAD MD","ppno":"434\/584-5027","pcpadd":"1755 N MECKLENBURG AVENUE","pcpcity":"SOUTH HILL","pcpstate":"VA","pcpzip":23970,"pcpcounty":"","pcpid":"","pcpname":"CMH PHYSICIAN SERVICES LLC","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":["F31.9","F33.9","F43.10","F33.1","F60.3","R10.9","H66.91","H69.91","F17.210","F43.22","T50.912A","E83.42","R41.82","R00.0","R68.2","F32.9","R21.","B49.","Z79.899","B37.0","I10.","G25.81","D47.3","E55.9","R00.2","N92.0","K50.90","K21.9","E66.01","N85.00","R94.31","T43.221A","T42.4X1A","T43.591A","G92.","NO DATA","Z68.41","F15.23","F13.239","F41.9","D64.9","E66.9","T14.91XA","T50.992A","R79.89","D50.9","D75.1","F10.920","Z80.9","T50.904A","R47.81","R44.3","I45.81","F10.10","F41.8","T42.4X4A","V62.84","R05.3","Z68.30","I48.92","Z87.19","F17.200","J44.1","Z23.","Z87.09","Z72.0"],"date":["2020-09-10","2020-09-10","2020-09-10","2021-05-05","2021-05-05","2021-08-10","2020-03-04","2020-03-04","2021-06-03","2020-07-21","2021-04-25","2021-04-26","2021-04-25","2021-05-06","2021-03-29","2021-04-29","2021-06-03","2021-06-03","2021-06-03","2021-02-03","2021-12-14","2021-12-14","2020-05-05","2020-05-05","2020-05-05","2020-05-05","2021-04-26","2021-12-14","2021-03-29","2020-11-23","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2021-12-14","2021-04-26","2021-04-26","2021-04-29","2021-12-14","2021-04-26","2021-12-14","2021-04-29","2021-04-29","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2021-04-25","2021-04-25","2021-04-25","2021-04-29","2021-04-26","2020-07-28","2021-04-29","2021-04-29","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2021-12-14","2019-09-26","2019-09-26","2019-12-26","2019-12-26"],"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":[["","","IMIPRAM","TAB 25MG","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","","ALPRAZOLAM","TAB 0.25MG","","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00093816201","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","","MEDROXYPR","TAB 10MG","","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","50111056101","TRAZODONE","TAB 100MG","90","Select","Select",""],["","76385011050","CARVEDILOL","TAB 3.125MG","180","Select","Select",""],["","68308015260","NYSTATIN","POW 100000","60","Select","Select",""],["","65862070460","ZIPRASIDONE","CAP 60MG","60","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","5","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","","ROPINIROLE","TAB 0.5MG","","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","23155022801","ACYCLOVIR","TAB 800MG","28","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","3","Select","Select",""],["","66993087761","CALCIPOTRIEN","CRE 0.00005","60","Select","Select",""],["","14539067501","HYDROXYZ","CAP 50MG","30","Select","Select",""],["","00074055402","HUMIRA","INJ 40\/0.4ML","2","Select","Select",""],["","45802004064","SELENIUM","LOT 0.025","120","Select","Select",""],["","54629064501","FERROUS","TAB 324MG","30","Select","Select",""],["","","ALLERGY","TAB 60-120MG","","Select","Select",""],["","00168000615","TRIAMCINOLON","OIN 0.001","60","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","00904671839","MUCUS","TAB 600MG ER","14","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","","LEVOFLOXACIN","TAB 500MG","","Select","Select",""],["","00904679489","ASPIRIN","CHW 81MG","30","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","00597002402","COMBIVENT","AER 20-100","4","Select","Select",""],["","57664050658","METOPROL","TAB 25MG","60","Select","Select",""],["","12843013105","BAYER","CHW 81MG","30","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","51672126301","NYSTAT\/TRIAM","CRE ","30","Select","Select",""],["","43386009663","CLOBETASOL","OIN 0.0005","45","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","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":""}]}]}