{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  NERDEKSTTAW L ","gend":1,"add":"ULOC 3521DAOR AIBM","city":"WOODBRIDGE","state":"VA","zip":"22191-9998","dob":"1980-03-09","age":"","mstatus":"","insh":"7851210*83","cliId":"","pno":"83\/7193764-3","cno":"917\/383-4673","email":"","ename":"","eno":"","pphy":"PROVANCE, PAUL T MD","ppno":"423\/794-1820","pcpadd":"105 W STONE DR STE 3A","pcpcity":"KINGSPORT","pcpstate":"TN","pcpzip":37660,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","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":["K92.0","K92.1","R94.5","G62.9","F41.1","F10.20","F32.1","Z23.","K92.2","K72.90","K20.9","K29.80","K70.31","K29.70","J45.909","Z79.899","Z01.812","Z20.828","F31.10","K76.0","D62.","R18.8","K76.6","K92.89","R63.6","J44.9","F31.70","F19.10","E55.9","R14.0","E87.6","D64.9","G57.93","K70.30","K21.9","I10.","F17.200","N91.2","K08.89","E87.1","R06.2","R63.4","D50.9","K74.60","F41.9","K76.9","J45.20","E83.42","F41.3","K22.11","E43.","R64.","I85.10","K29.71","I86.4","I95.9","K42.9","K31.89"],"date":["2020-08-19","2020-06-04","2022-03-25","2021-05-27","2022-07-12","2022-07-12","2022-07-12","2022-02-07","2020-06-08","2020-06-08","2020-06-08","2020-06-04","2022-02-07","2020-06-18","2021-02-10","2020-06-18","2020-08-19","2020-08-19","2021-06-24","2022-06-17","2020-06-07","2020-09-10","2020-09-10","2020-08-20","2020-08-20","2022-08-08","2022-02-07","2022-08-08","2022-02-07","2022-02-07","2022-08-08","2021-02-10","2020-06-12","2022-01-20","2020-06-04","2020-06-04","2020-06-04","2022-08-08","2022-08-08","2020-06-03","2020-06-03","2020-09-10","2020-09-10","2021-05-27","2021-05-27","2022-05-03","2020-06-07","2021-07-22","2021-07-22","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-06-03","2020-08-20"],"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":[["","68382050010","OMEPRAZOLE","CAP 40MG","180","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","90","Select","Select",""],["","53746051401","SPIRONOLACT","TAB 50MG","30","Select","Select",""],["","70436005801","BUPROPION","TAB 100MG SR","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","76329630005","LIDOCAINE","SOL 0.04","24","Select","Select",""],["","00173085910","BREO","INH 100-25","60","Select","Select",""],["","08290236712","LACTINEX","GRA ","90","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","90","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","360","Select","Select",""],["","11917009215","FERROUS","TAB 325MG","90","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","30","Select","Select",""],["","40985021339","ACIDOPHILUS","CAP HIGH-POT","100","Select","Select",""],["","65862015901","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","65862048901","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","16729008110","NALTREXONE","TAB 50MG","30","Select","Select",""],["","67405065105","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00378932032","WIXELA","AER 100\/50","60","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","60","Select","Select",""],["","00173069500","ADVAIR","AER 100\/50","60","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","6","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","90","Select","Select",""],["","00032301628","CREON","CAP 36000UNT","300","Select","Select",""],["","00904621448","FEXOFENADINE","TAB 180MG","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":""}]}]}