{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" T  TREBORRJ ELKNIH","gend":0,"add":"TENNEB 602DR NWOT T","city":"COVINGTON","state":"VA","zip":24426,"dob":"1980-09-07","age":"","mstatus":"","insh":"7821210*28","cliId":"","pno":"59\/0455234-8","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"304\/645-3220","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":24426,"pcpcounty":"","pcpid":"","pcpname":"WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE CLINIC INC","plan":"OHP","program":"Medicaid","lob":"M4","region":"ROANOKE\/ ALLEGHANY","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":["E10.21","J45.990","F17.210","Z68.26","E10.40","Z23."],"date":["2020-03-16","2020-03-16","2020-03-16","2020-03-16","2019-12-16","2019-12-16"],"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":[["","00169750111","NOVOLOG","INJ 100\/ML","10","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","60","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","08290324911","INSULIN","MIS 0.5\/31G","100","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","08396901534","RELION","MIS 31GX6MM","150","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","DULOXETINE","CAP 60MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","65862019430","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}