{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"E   ARUALRELDNAHC ","gend":1,"add":"N TEERTS DLEIFHCTIL 701MUCRAM NIVEK 231E TPA W","city":"COEBURN","state":"VA","zip":"24230-9998","dob":"1973-02-07","age":"","mstatus":"","insh":"60500210*92","cliId":"","pno":"25\/6724055-3","cno":"276\/523-5504","email":"","ename":"","eno":"","pphy":"GREEN, THOMAS W MD","ppno":"423\/844-1121","pcpadd":"1 MEDICAL PARK BLVD","pcpcity":"BRISTOL","pcpstate":"TN","pcpzip":37620,"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":["L02.31","I96.","I25.2","I25.10","E78.5","E78.00","K21.9","I10.","Z95.5","M19.90","G89.29","Z79.82","M10.9","R56.9","Z68.38","E66.9","F17.210","R07.89","M79.602","R51.9","L03.317","R22.9","L03.90","F41.9","Z88.5","Z88.8","R06.02","J06.9","Z72.0","I63.9","R20.0","G43.809","Z79.899","L89.309","L23.5","R22.0","L29.9"],"date":["2020-07-30","2020-07-22","2020-07-22","2020-07-22","2020-07-30","2020-07-22","2021-10-24","2021-10-26","2020-07-22","2020-07-30","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2020-07-22","2021-10-24","2021-10-24","2021-10-24","2021-10-26","2020-07-20","2020-07-20","2020-07-20","2020-07-30","2020-07-30","2020-07-30","2020-08-15","2020-08-15","2021-10-26","2021-10-26","2021-10-26","2021-10-24","2021-10-24","2020-07-30","2020-10-09","2020-10-09","2020-10-09"],"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":[["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","43547035411","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","60","Select","Select",""],["","55111028130","LEVOFLOXACIN","TAB 750MG","10","Select","Select",""],["","47781019601","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","16714008110","HYDROXYZ","TAB 10MG","15","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":""}]}]}