{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NAMSAYREILLOC S","gend":1,"add":"US 0001RD XESS","city":"EMPORIA","state":"VA","zip":"23847-9998","dob":"1972-02-02","age":"","mstatus":"","insh":"65200210*73","cliId":"","pno":"95\/4345625-4","cno":"","email":"","ename":"","eno":"","pphy":"ANDERSON, MICHAEL S MD","ppno":"434\/634-6101","pcpadd":"6 DOCTORS DRIVE","pcpcity":"EMPORIA","pcpstate":"VA","pcpzip":23847,"pcpcounty":"","pcpid":"","pcpname":"EMPORIA MEDICAL ASSOCIATES PC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R50.9","R11.0","G40.909","R60.9","E03.9","F72.","Z23.","J30.9","F79.","R32.","R11.10","R53.1","R22.0","R68.84","E87.6","R11.2","Z79.899","G31.84","I10.","E66.9"],"date":["2020-03-09","2020-03-09","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2020-09-24","2021-12-07","2021-12-07","2020-05-28","2020-05-28","2019-07-07","2019-07-07","2019-11-08","2019-11-08","2019-11-06","2019-11-06","2019-05-20","2019-05-20"],"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":[["","00378021610","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","00603154258","POT  CHLORIDE","SOL 0.1","480","Select","Select",""],["","65162036111","FOLIC","TAB 1MG","30","Select","Select",""],["","10006073038","MAG","TAB 400MG","30","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00603150858","PHENOBARB","ELX 20MG\/5ML","946","Select","Select",""],["","00378180510","LEVOTHYROXIN","TAB 75MCG","30","Select","Select",""],["","51672400501","CARBAMAZEPIN","TAB 200MG","120","Select","Select",""],["","51672213108","LORATADINE","SOL 5MG\/5ML","180","Select","Select",""],["","00121067516","VALPROIC","SOL 250\/5ML","946","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","21922002107","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","","CEFPROZIL","SUS 250\/5ML","","Select","Select",""],["","68180030360","CEFUROXIME","TAB 500MG","20","Select","Select",""],["","50383080116","PROMETHAZINE","SYP 6.25\/5ML","180","Select","Select",""],["","","NYSTATIN","CRE 100000","","Select","Select",""],["","","ONDANSETRON","SOL 4MG\/5ML","","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","30","Select","Select",""],["","00574402235","BACITRACIN","OIN OP","4","Select","Select",""],["","60432024516","APAP\/CODEINE","SOL 120-12\/5","120","Select","Select",""],["","68180044101","CEPHALEXIN","SUS 250\/5ML","300","Select","Select",""],["","50428912837","ALLERGY","SYP 5MG\/5ML","180","Select","Select",""],["","51801001130","EFFER-K","TAB 20MEQ","30","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":""}]}]}