{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YNAFFITNISUOC L ","gend":1,"add":"ERREF E 727A TPA TS LL","city":"SOUTH HILL","state":"VA","zip":"23970-9998","dob":"1977-09-22","age":"","mstatus":"","insh":"7438110*91","cliId":"","pno":"57\/4347641-5","cno":"434\/430-5233","email":"","ename":"","eno":"","pphy":"ACKERMAN, CHRISTOPHER J MD","ppno":"434\/848-0771","pcpadd":"203 SHARP ST","pcpcity":"LAWRENCEVILLE","pcpstate":"VA","pcpzip":23868,"pcpcounty":"","pcpid":"","pcpname":"LAWRENCEVILLE PRIMARY CARE PC","plan":"OHP","program":"MEDICAID","lob":"M4","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":["Z30.42","J44.1","K21.9","I11.9","M19.90","G93.5","G43.909","M54.2","M54.5","Z79.899","A08.19","R53.83","D25.9","F11.20","Z79.891","M47.816","M51.36","M50.30","M79.7","J44.9","R51.9","N83.209","N93.8","R10.2","E87.6","N83.12","I10.","E78.00","J30.9","J45.20","Z32.02","E07.9","K04.7","F17.210"],"date":["2021-11-05","2020-02-10","2020-04-14","2021-04-01","2021-04-01","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2021-07-20","2019-04-08","2019-04-08","2020-05-30","2019-11-11","2019-11-11","2019-11-11","2019-11-11","2019-11-11","2019-11-11","2020-04-14","2021-09-02","2020-05-30","2020-05-30","2020-05-30","2020-05-30","2020-06-09","2019-01-16","2019-01-16","2019-01-16","2019-01-16","2020-09-04","2020-06-30","2020-09-12","2020-09-12"],"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":[["","","HYDROCHLOROT"," HYDROCHLOROT ","30","Select","Select",""],["","","RANITIDINE"," RANITIDINE ","60","Select","Select",""],["","","OXYCOD\/APAP"," OXYCOD\/APAP ","90","Select","Select",""],["","","LYRICA"," LYRICA ","60","Select","Select",""],["","","VENTOLIN"," VENTOLIN ","18","Select","Select",""],["","","PROVENTIL"," PROVENTIL ","13","Select","Select",""],["","","TIZANIDINE"," TIZANIDINE ","90","Select","Select",""],["","","LOVASTATIN"," LOVASTATIN ","30","Select","Select",""],["","","MONTELUKAST"," MONTELUKAST ","30","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","13","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","6","Select","Select",""],["","","IMODIUM"," IMODIUM ","16","Select","Select",""],["","","BUTRANS"," BUTRANS ","4","Select","Select",""],["","","BUPRENORPHIN"," BUPRENORPHIN ","4","Select","Select",""],["","","PREGABALIN"," PREGABALIN ","60","Select","Select",""],["","","LANSOPRAZOLE","CAP 30MG DR","","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","","DOXYCYCL","TAB 100MG","","Select","Select",""],["","","POT  CHLORIDE","TAB 10MEQ ER","","Select","Select",""],["","","KETOROLAC","TAB 10MG","","Select","Select",""],["","","CLINDAMYCIN","CAP 150MG","","Select","Select",""],["","","LIDOCAINE","SOL 2% VISC","","Select","Select",""],["","","MEDROXYPR","INJ 150MG\/ML","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","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":""}]}]}