{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YERFFEJESOR B  ","gend":0,"add":"KMOT 033DAOR NE","city":"CLINTWOOD","state":"VA","zip":"24228-9998","dob":"1985-08-14","age":"","mstatus":"","insh":"6858110*11","cliId":"","pno":"29\/6726909-6","cno":"","email":"","ename":"","eno":"","pphy":"ADDISON, SAMANTHA GIBSON FNP","ppno":"276\/523-6715","pcpadd":"323 CLOVERLEAF SQ # 1","pcpcity":"BIG STONE GAP","pcpstate":"VA","pcpzip":24219,"pcpcounty":"","pcpid":"","pcpname":"WELLMONT MEDICAL ASSOCIATES INC","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":["I10.","K21.9","F51.01","M19.071","Z79.899","M15.0","J01.90","M15.4","G43.909","F33.1","R06.81","R51.9","G47.19","F17.200","R07.9","J06.9","R42.","F17.210","F17.290","Z20.822","Z63.4","Z00.00","Z13.220","R68.82","M25.571","B35.3","G89.29","G47.30","J44.9","M76.821","R07.89","Z72.0","M54.2","G95.0","I65.23","M54.9"],"date":["2021-12-20","2021-12-20","2021-08-27","2021-07-30","2021-08-27","2021-05-07","2021-06-04","2021-08-27","2021-09-24","2021-09-24","2020-11-04","2020-11-04","2020-11-04","2020-11-04","2021-11-23","2021-11-23","2022-11-03","2021-11-23","2021-11-23","2021-11-23","2021-02-17","2020-06-18","2020-06-18","2020-06-18","2020-07-27","2020-07-27","2022-11-03","2021-01-22","2021-01-22","2020-10-29","2021-11-23","2021-11-23","2022-08-02","2022-11-03","2022-08-02","2022-11-03"],"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":[["","68462039710","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00363042162","NICOTINE","GUM 4MG STRT","110","Select","Select",""],["","59651036205","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","60","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","90","Select","Select",""],["","33342009441","RIZATRIPTAN","TAB 10MG ODT","12","Select","Select",""],["","42806041160","BUPROPION","TAB 200MG SR","60","Select","Select",""],["","00378001805","METOPROL","TAB 25MG","90","Select","Select",""],["","16729018317","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00135019401","NICODERM","DIS 21MG\/24H","28","Select","Select",""],["","68462026290","ROSUVASTATIN","TAB 10MG","30","Select","Select",""],["","00713050324","ANUCORT-HC","SUP 25MG","12","Select","Select",""],["","00037682210","PROCTOFOAM","AER HC 1%","10","Select","Select",""],["","58914030180","RECTIV","OIN 0.004","30","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00574709012","HYDROCORT","SUP 25MG","12","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","00093553801","ESZOPICLONE","TAB 2MG","15","Select","Select",""],["","11917008200","BP","MIS AUTOMATI","1","Select","Select",""],["","00115165901","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","00406052201","OXYCOD\/APAP","TAB 7.5-325","120","Select","Select",""],["","68462015305","TOPIRAMATE","TAB 50MG","90","Select","Select",""],["","11917013064","PULSE","MIS OXIMETER","1","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","71093015504","ZOLPIDEM","TAB 5MG","15","Select","Select",""],["","23155053006","TROSPIUM","TAB 20MG","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","63304073430","ESOMEPRA","CAP 20MG DR","60","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","30","Select","Select",""],["","00009540001","NICOTROL","INH ","168","Select","Select",""],["","68462029817","CLOTRIM\/BETA","CRE DIPROP","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","300","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":""}]}]}