{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ACSODALWOLLID ","gend":1,"add":"UR 741NL YBG","city":"NORTH TAZEWELL","state":"VA","zip":"24630-9998","dob":"1992-07-22","age":"","mstatus":"","insh":"7789110*47","cliId":"","pno":"23\/0458383-6","cno":"","email":"","ename":"","eno":"","pphy":"TURSKI, JOHN T DO","ppno":"276\/688-4331","pcpadd":"12301 GRAPEFIELD ROAD","pcpcity":"BASTIAN","pcpstate":"VA","pcpzip":24314,"pcpcounty":"","pcpid":"","pcpname":"BLAND COUNTY MEDICAL CLINIC 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":["K80.20","M54.2","R51.","R07.89","R07.9","M54.12","H60.333","Z71.3","Z71.82","Z13.31","Z68.28","R10.11","Z68.27","K81.9","G43.009","G44.40","H81.11","T39.95XA","J02.9","K91.5","T50.905A","R10.13","K21.9","Z86.19","K29.80","R00.2","Z87.19","Z01.812","Z20.828","K29.90","M62.838","R42.","E16.2","Z68.32"],"date":["2019-05-06","2020-01-22","2020-08-24","2019-09-18","2019-08-13","2019-08-13","2019-08-13","2020-08-24","2020-08-24","2020-08-24","2019-08-13","2020-11-03","2019-03-14","2019-05-06","2019-06-25","2019-06-25","2019-06-25","2019-06-25","2020-07-11","2020-09-07","2020-09-07","2020-11-03","2021-08-23","2020-10-29","2020-11-03","2019-09-17","2020-09-22","2020-10-29","2020-10-29","2020-12-07","2019-03-05","2019-03-05","2020-08-24","2020-08-24"],"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":{"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":[["","","HYDROCO\/APAP"," HYDROCO\/APAP ","20","Select","Select",""],["","","KETOROLAC"," KETOROLAC ","20","Select","Select",""],["","","CIPROFLOXACN"," CIPROFLOXACN ","28","Select","Select",""],["","","BISMUTH","CHW 262MG","","Select","Select",""],["","","TETRACYCLINE","CAP 500MG","","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","","LANSOPRAZOLE","CAP 30MG DR","","Select","Select",""],["","","LANSOPR\/AMOX","MIS \/CLARITH","","Select","Select",""],["","","PANTOPRAZOLE","TAB 40MG","","Select","Select",""],["","","SUCRALFATE","TAB 1GM","","Select","Select",""],["","","LIDOCAINE","SOL 2% VISC","","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":""}]}]}