{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YHTOMITNHAI J  ","gend":0,"add":"SOMTAHC 662A TPA TC S","city":"MARTINSVILLE","state":"VA","zip":"24112-9998","dob":"1961-07-21","age":"","mstatus":"","insh":"69200210*43","cliId":"","pno":"43\/6728208-0","cno":"276\/336-1575","email":"","ename":"","eno":"","pphy":"WALSH, FRANCIS MD","ppno":"276\/632-4181","pcpadd":"SUITE A 101 CLEVELAND AVE","pcpcity":"MARTINSVILLE","pcpstate":"VA","pcpzip":24112,"pcpcounty":"","pcpid":"","pcpname":"EUGENE C MADONIA MD SHUBHA A CHUMBLE MD FRANC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","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":["Z03.818","J44.1","J44.0","R06.02","F31.9","I10.","F31.10","E03.9","G47.00","R21.","K63.5","Z86.010","E78.5","Z12.11","D12.4","D12.3","M51.36","M54.32","R73.01","Z12.5","Z11.59","H91.90","NO DATA","F41.1","H53.8","Z01.812","D12.0","D12.2","Z80.0","Z01.810","N52.9","F17.290","M25.559","M54.42","J45.21"],"date":["2020-09-13","2020-09-13","2020-09-13","2020-09-13","2021-06-03","2021-11-04","2021-09-01","2021-09-28","2021-09-01","2021-09-01","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2020-01-24","2020-01-24","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-01-18","2021-09-23","2021-09-28","2021-09-28","2021-09-28","2021-11-01","2021-09-28","2021-09-28","2019-05-28","2019-03-29","2019-03-08"],"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":[["","65862076990","FENOFIBRATE","TAB 145MG","30","Select","Select",""],["","00378623301","CITALOPRAM","TAB 40MG","30","Select","Select",""],["","00093321915","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","90","Select","Select",""],["","23155060701","GLYCOPYRROL","TAB 2MG","90","Select","Select",""],["","70710122600","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","50428050854","CVS","PAK ","30","Select","Select",""],["","72578008801","NYSTAT\/TRIAM","OIN ","15","Select","Select",""],["","00228277911","PROPRANOLOL","CAP 80MG ER","30","Select","Select",""],["","00093321205","CLONAZEPAM","TAB 1MG","30","Select","Select",""],["","67877025130","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","45802086866","POLYETH","POW 3350 NF","28","Select","Select",""],["","65862068890","SILDENAFIL","TAB 20MG","30","Select","Select",""],["","61874011530","VRAYLAR","CAP 1.5MG","30","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","51672404801","CLOTRIM\/BETA","CRE DIPROP","15","Select","Select",""],["","65862059501","DIVALPROEX","TAB 500MG ER","270","Select","Select",""],["","","LOPERAMIDE","CAP 2MG","","Select","Select",""],["","50428232907","ANTI-DIARRHE","TAB 2MG","60","Select","Select",""],["","00378180510","LEVOTHYROXIN","TAB 75MCG","90","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","","COMBIVENT","AER 20-100","","Select","Select",""],["","57664050083","MIRTAZAPINE","TAB 30MG","30","Select","Select",""],["","00143973910","PREDNISONE","TAB 10MG","32","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00093026215","FLUOCINONIDE","CRE 0.0005","30","Select","Select",""],["","","ATORVASTATIN","TAB 40MG","","Select","Select",""],["","","FLUBLOK","INJ 2020-21","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","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":""}]}]}