{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ELLENYLNOSNHOJ","gend":1,"add":"OB OP87 X","city":"HORNTOWN","state":"VA","zip":"23395-9998","dob":"1971-11-08","age":"","mstatus":"","insh":"7940810*39","cliId":"","pno":"96\/7579695-4","cno":"","email":"","ename":"","eno":"","pphy":"CONIGLIO, ROBERT PA","ppno":"757\/824-5676","pcpadd":"5219 LANKFORD HWY","pcpcity":"NEW CHURCH","pcpstate":"VA","pcpzip":23415,"pcpcounty":"","pcpid":"","pcpname":"EASTERN SHORE RURAL HEALTH SYSTEM INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D64.9","I10.","K21.9","N92.1","K29.70","Z86.010","B96.81","Z01.411","N89.8","A59.01","D25.9","N93.9","N94.5","D50.0","Z30.014","R20.0","Z23.","N92.4","Z92.89","R19.5","D53.9","Z86.018","Z11.1","Z92.29","K63.5","K29.50","K64.0","K57.30","Q43.8","Z78.0","Z71.3","M79.622","E66.3","Z68.26","N39.0","N92.0"],"date":["2021-04-19","2021-11-08","2021-06-02","2021-04-12","2019-11-18","2019-11-18","2019-11-18","2021-02-15","2021-02-15","2021-04-19","2021-05-21","2021-06-24","2021-05-21","2021-05-21","2021-05-21","2021-12-06","2021-10-01","2021-07-28","2021-07-28","2019-09-04","2019-09-10","2021-04-12","2020-08-11","2021-10-01","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2019-09-10","2021-06-02","2021-11-08","2021-08-23","2021-08-23","2021-08-23","2020-04-24","2021-01-12"],"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":[["","","HYDROCHLOROT"," HYDROCHLOROT ","30","Select","Select",""],["","","FEROSUL"," FEROSUL ","90","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","28","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","","RA"," RA ","90","Select","Select",""],["","","FAMOTIDINE"," FAMOTIDINE ","30","Select","Select",""],["","","FERROUS"," FERROUS ","90","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","28","Select","Select",""],["","","CLARITHROMYC"," CLARITHROMYC ","28","Select","Select",""],["","","PRILOSEC"," PRILOSEC ","28","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","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":""}]}]}