{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  NOSIDAMNIRRUC N ","gend":1,"add":"LLEPAC 7027153 TOL NL A","city":"ABINGDON","state":"VA","zip":"24210-9998","dob":"2004-02-27","age":"","mstatus":"","insh":"7675110*47","cliId":"","pno":"12\/3241888-7","cno":"423\/217-7976","email":"","ename":"","eno":"","pphy":"BLANKENSHIP, JONATHAN D DO","ppno":"423\/990-2400","pcpadd":"240 MEDICAL PARK BLVD STE 2000","pcpcity":"BRISTOL","pcpstate":"TN","pcpzip":37620,"pcpcounty":"","pcpid":"","pcpname":"HOLSTON MEDICAL GROUP PC","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":["R21.","F41.1","F33.9","F41.9","R11.0","Z30.41","K21.9","R10.9","N39.0","N92.0","K59.00","J02.0","J02.9","B34.9","R09.81","Z20.822","R39.9","R31.9","S02.2XXA","W22.8XXA","Z01.419"],"date":["2020-03-10","2021-01-05","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-07","2022-10-07","2022-10-07","2022-10-07","2020-03-04","2021-10-18","2021-10-18","2021-10-18","2021-12-31","2022-09-19","2022-09-19","2020-10-23","2020-10-23","2020-06-24"],"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":[["","70700015010","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","68382002101","VENLAFAXINE","TAB 75MG","180","Select","Select",""],["","68180090213","DROSPIR\/ETHI","TAB 3-0.03MG","84","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","180","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","30","Select","Select",""],["","00378623201","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","11917019062","GLYCERIN","SUP 2GM","25","Select","Select",""],["","45802086802","POLYETH","POW 3350 NF","238","Select","Select",""],["","59762005501","MEDROXYPR","TAB 2.5MG","10","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","00555901658","SPRINTEC","TAB 28 DAY","28","Select","Select",""],["","68180044101","CEPHALEXIN","SUS 250\/5ML","300","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","59762371809","TRIAZOLAM","TAB 0.25MG","1","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","23155050105","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00126008802","PREVIDENT","GEL 1.1% MIN","56","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","56","Select","Select",""],["","00555913167","OCELLA","TAB 3-0.03MG","84","Select","Select",""],["","65162018910","NAPROXEN","TAB 375MG","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":""}]}]}