{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NETSIRKKRALC ","gend":1,"add":"OB OP381 X","city":"PENNINGTON GAP","state":"VA","zip":"24277-9998","dob":"1991-07-16","age":"","mstatus":"","insh":"5241210*99","cliId":"","pno":"22\/6725915-0","cno":"276\/220-5195","email":"","ename":"","eno":"","pphy":"COUCH, JILL K DO","ppno":"276\/546-3001","pcpadd":"276 FIELDSTONE DRIVE","pcpcity":"JONESVILLE","pcpstate":"VA","pcpzip":24263,"pcpcounty":"","pcpid":"","pcpname":"","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":["F41.9","E66.9","F32.9","F33.0","Z00.8","Z13.89","F17.200","G47.00","H04.123","H52.13","H52.223","Z79.899","S32.001S","Z13.9","R11.2","K04.7","S32.001A","F17.210","R11.0","S32.031A","W17.89XA","Z20.822","M25.50","Z71.89","S32.032A","Z23.","S24.103A","NO DATA","R33.9","E66.8","Z68.33","R73.9","E87.8","D72.829","K59.00","E87.6","Z04.3","M62.81","M54.5"],"date":["2020-07-26","2020-05-26","2020-07-26","2020-05-26","2020-12-07","2020-12-07","2020-12-07","2020-05-26","2020-05-29","2020-05-29","2020-05-29","2020-09-10","2020-12-07","2020-12-07","2021-02-17","2021-10-05","2020-09-15","2021-10-05","2021-10-05","2020-07-25","2020-07-25","2021-02-17","2020-05-26","2020-05-26","2021-02-24","2020-10-01","2020-07-26","2020-07-26","2020-07-26","2020-07-26","2020-07-26","2020-07-26","2020-07-26","2020-07-26","2020-07-26","2020-07-26","2020-07-26","2020-09-09","2020-09-09"],"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":[["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","00406012505","HYDROCO\/APAP","TAB 10-325MG","16","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","65862017605","PENICILLN","TAB 500MG","40","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","00378623305","CITALOPRAM","TAB 40MG","90","Select","Select",""],["","00115165903","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","69097015915","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","70010075405","METHOCARBAM","TAB 500MG","90","Select","Select",""],["","43386043201","OXYCODONE","TAB 5MG","28","Select","Select",""],["","67877022305","GABAPENTIN","CAP 300MG","14","Select","Select",""],["","47781019605","OXYCOD\/APAP","TAB 5-325MG","21","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","90","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":""}]}]}