{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   LEGNANOSBIG D","gend":1,"add":"ROFTER 2312155B TPA DR D","city":"COEBURN","state":"VA","zip":"24230-9998","dob":"2001-05-24","age":"","mstatus":"","insh":"7775110*75","cliId":"","pno":"75\/8287779-8","cno":"","email":"","ename":"","eno":"","pphy":"RUMLEY, WENDY N NP","ppno":"276\/679-5880","pcpadd":"601 COMMONWEALTHR","pcpcity":"NORTON","pcpstate":"VA","pcpzip":24273,"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":["F11.20","Z79.899","O99.320","F12.10","F17.210","NO DATA","R10.9","Z53.21","R10.31","F11.21","F17.200","F41.9","F15.10","N91.2","Z3A.01","R11.0","O03.4","Z3A.10","R07.89","R11.2","J45.909","I47.1","M71.169","R10.84","F12.20","M25.462","R07.9","R10.30","K04.7","K08.89","R22.0","Z20.822","O26.891","Z3A.08","K52.9","R06.02","Z34.91","R10.2","Z32.01","O99.322","Z72.0","M54.9"],"date":["2022-11-16","2021-11-29","2021-12-13","2022-11-16","2022-04-19","2022-04-27","2021-11-16","2021-11-16","2021-11-16","2022-04-14","2022-11-16","2022-11-16","2022-11-16","2021-11-11","2021-10-23","2021-10-23","2021-12-05","2021-12-05","2022-04-19","2022-03-14","2022-04-27","2022-04-27","2022-05-09","2020-03-01","2021-11-01","2022-04-19","2022-04-19","2021-12-05","2021-09-26","2021-09-26","2021-09-26","2021-12-05","2021-11-17","2021-10-23","2022-03-14","2022-04-19","2021-11-17","2021-11-17","2021-11-11","2021-11-11","2020-03-02","2021-12-05"],"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":[["","00054018913","BUPREN\/NALOX","SUB 8-2MG","14","Select","Select",""],["","00093220305","METOCLOPRAM","TAB 10MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00093314505","CEPHALEXIN","CAP 250MG","10","Select","Select",""],["","42571025201","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","60258019309","PRENATABS","TAB ","30","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","56","Select","Select",""],["","31604001499","MULTI","TAB ","30","Select","Select",""],["","00904699880","DOCUSATE","CAP 100MG","56","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","39328010650","PRENATAL","TAB 27-1MG","30","Select","Select",""],["","69543025810","PREPLUS","TAB 27-1MG","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":""}]}]}