{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ROLYATEETRAB M","gend":1,"add":"M EESSEJ 53151 TPA DR LLI","city":"CLEVELAND","state":"VA","zip":"24225-9998","dob":"1999-10-23","age":"","mstatus":"","insh":"7775110*78","cliId":"","pno":"97\/6726022-4","cno":"276\/794-2206","email":"","ename":"","eno":"","pphy":"LEE, DANE MD","ppno":"276\/619-6128","pcpadd":"24530 FALCON PLACE BLVD STE 102","pcpcity":"ABINGDON","pcpstate":"VA","pcpzip":24211,"pcpcounty":"","pcpid":"","pcpname":"","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":["F33.1","F15.20","F11.20","F12.10","N20.0","R10.9","N39.0","Z03.818","R89.9","J20.9","R11.2","R05.","N10.","F31.31","A41.9","N12.","Z20.822","U07.1","Z01.818","Z46.6","Z30.41","N20.1","R31.29","Z96.0","N13.30","R30.0","S80.11XA","S50.12XA","R21.","X58.XXXA","R03.0","R31.9","F41.1","Z20.828","T83.192A","N21.0","Z86.19","L03.90","R50.9","B34.9","N13.6","Z87.442","Z91.048","N23.","M54.6","F19.10","I87.8","Z90.49","Z91.040","F31.32","Z88.8","R00.0","K22.4","J00.","R11.0","N13.2","O99.891","O26.851","R55.","NO DATA","D64.9","R53.83","R63.4","R74.8","I87.1","R10.31","R10.32","N20.2","Z53.21","R20.0","M79.89","S61.511A","Z23.","L03.113","L03.114","N92.6","Z18.9","O03.9","K04.7","B37.9","T36.95XA"],"date":["2022-02-09","2022-09-27","2022-09-27","2021-03-30","2022-04-20","2022-04-04","2022-09-28","2022-04-15","2022-09-27","2020-10-19","2020-10-19","2020-10-19","2021-06-10","2021-02-25","2021-06-12","2021-06-09","2022-04-15","2022-03-04","2022-03-04","2022-04-20","2022-09-08","2021-03-10","2020-12-22","2022-03-05","2021-06-10","2021-03-04","2020-08-25","2020-08-25","2022-03-05","2020-08-25","2022-07-06","2021-03-04","2020-09-01","2020-05-13","2021-03-10","2021-03-10","2021-03-23","2022-02-09","2021-06-10","2021-01-11","2021-06-10","2021-06-10","2021-06-10","2020-03-07","2020-03-10","2022-03-05","2022-03-05","2022-03-05","2022-03-05","2020-03-17","2022-01-09","2020-08-10","2020-08-10","2021-05-25","2022-04-04","2021-06-11","2022-04-04","2022-04-04","2022-07-06","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2022-09-28","2022-03-05","2022-03-05","2022-04-20","2020-08-10","2020-08-10","2020-08-25","2020-08-31","2020-08-31","2020-09-20","2020-09-20","2020-11-02","2022-02-22","2022-04-04","2022-05-05","2022-05-05","2022-05-05"],"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":[["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","51293081101","PHENAZOPYRID","TAB 200MG","15","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","9","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00054350049","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","43547035150","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","00430042014","LO","TAB 40452","28","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","7","Select","Select",""],["","65757030001","VIVITROL","INJ 380MG","4","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","65862064169","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","70954005920","PREDNISONE","TAB 10MG","5","Select","Select",""],["","62332003831","LAMOTRIGINE","TAB 100MG","30","Select","Select",""],["","70954000520","OXYBUTYNIN","TAB 5MG","21","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","20","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","20","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","20","Select","Select",""],["","67877024901","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","60","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","51672128402","TRIAMCINOLON","OIN 0.001","30","Select","Select",""],["","33332032001","AFLURIA","INJ 2020-21","0","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","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":""}]}]}