{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" IRRETWELEB","gend":1,"add":"NEDNIL S 335F8 TPA EVA ","city":"WAYNESBORO","state":"VA","zip":"22980-9998","dob":"1988-05-04","age":"","mstatus":"","insh":"7066110*90","cliId":"","pno":"03\/4345048-5","cno":"434\/305-8405","email":"","ename":"","eno":"","pphy":"CAMPBELL JR, BRUCE D MD","ppno":"434\/978-1691","pcpadd":"4304 FREE UNION RD","pcpcity":"FREE UNION","pcpstate":"VA","pcpzip":22940,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","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":["R07.9","O26.873","Z3A.29","Z34.80","Z20.828","F44.9","G90.522","Z13.858","V23.41","Z36.0","Z3A.09","F34.1","R00.1","O26.891","R07.89","M54.2","R06.02","O48.0","O99.354","Z37.0","G25.0","Z3A.40","Z88.8","Z86.59","Z82.49","Z83.3","R07.0","R06.2","F32.9","G98.8","F41.9","L65.0","T50.905A","N89.8","Z34.90","O26.872","Z3A.28","O99.89","R10.9","O80.","Z01.818","N93.8","Z3A.11","Z79.899","N71.0","M54.5","NO DATA","Z3A.35","Z3A.36","M70.52","L03.115","O26.843","Z3A.34","N76.0","N93.9"],"date":["2020-01-28","2020-07-17","2020-05-29","2020-07-28","2020-12-08","2022-10-28","2022-10-28","2022-10-28","2020-07-08","2020-01-13","2020-01-13","2021-12-01","2022-10-28","2020-01-27","2020-01-27","2020-01-27","2020-01-27","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-12-08","2021-11-17","2021-11-17","2021-11-17","2022-10-27","2022-03-22","2022-10-27","2020-01-06","2020-01-27","2020-05-22","2020-05-22","2020-08-14","2020-08-14","2020-08-20","2020-08-04","2022-05-31","2020-01-27","2020-01-27","2020-12-29","2020-12-29","2020-01-28","2020-07-08","2020-07-17","2021-03-03","2021-06-21","2020-07-01","2020-07-01","2021-10-21","2022-03-31"],"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":[["","00555901658","SPRINTEC","TAB 28 DAY","84","Select","Select",""],["","43598075205","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","62332002231","FLUOXETINE","CAP 10MG","90","Select","Select",""],["","16714040504","LARIN","TAB 1.5\/30","28","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","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":""}]}]}