{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  HAIHSA'YZWEHTTAM L ","gend":1,"add":"OB OP711 X","city":"BLOXOM","state":"VA","zip":"23308-9998","dob":"2002-07-06","age":"","mstatus":"","insh":"8011810*57","cliId":"","pno":"98\/7571251-4","cno":"","email":"","ename":"","eno":"","pphy":"HALLS, ALBERT JOHN MD","ppno":"757\/787-7374","pcpadd":"20306 BADGER LANE","pcpcity":"ONLEY","pcpstate":"VA","pcpzip":23418,"pcpcounty":"","pcpid":"","pcpname":"EASTERN SHORE RURAL HEALTH SYSTEM INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["K50.80","R11.0","R10.33","R79.82","K50.90","R10.9","R11.10","Z20.828","Z79.899","Z11.59","U07.1","R11.2","R10.31","R10.11","R63.4","Z20.822","M25.561","M25.551","R70.0","Z11.3","N76.0","R11.11","A08.4","K50.818","E46.","E88.09","R00.0","V58.69","K29.60","NO DATA","M25.562","G89.29","N89.8","R10.30","Z13.31","Z91.14","R10.84","R62.51","Z00.00","Z30.016","Z86.2","Z71.82","Z71.3","Z23.","Z30.013","D63.8","R05.","R50.9","Z87.19","R10.10","K22.2","E43.","K52.9","R42.","R10.13","Z00.129","N92.0","F43.21","J02.0","K22.3","K50.00","R10.12","K59.00","Z68.52","R51.","D64.9","D47.3","Z91.128","K31.0","H10.021","D50.8","K21.9"],"date":["2021-12-30","2021-02-02","2021-12-30","2021-11-01","2021-08-31","2020-11-12","2020-11-12","2021-09-17","2021-11-01","2020-08-12","2021-12-30","2020-10-16","2020-11-13","2020-11-13","2020-11-13","2021-08-24","2021-08-31","2021-08-31","2021-11-01","2021-10-31","2021-10-31","2021-12-30","2020-01-28","2020-11-10","2020-11-10","2021-08-06","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2021-06-24","2021-05-22","2021-08-12","2021-08-12","2021-05-28","2020-02-14","2020-10-16","2020-10-16","2020-07-21","2020-07-21","2020-07-21","2020-07-21","2020-09-18","2020-07-21","2020-09-18","2021-02-02","2021-08-24","2021-08-24","2021-12-22","2021-12-22","2019-06-19","2019-06-19","2019-10-02","2019-10-02","2019-04-19","2019-04-26","2019-04-26","2019-06-14","2019-03-15","2019-06-20","2019-06-20","2019-10-01","2019-10-01","2019-06-12","2019-06-12","2019-06-12","2019-06-12","2019-06-12","2019-06-12","2019-12-13","2019-12-13","2019-08-29"],"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":[["","","ONDANSETRON"," ONDANSETRON ","90","Select","Select",""],["","","STELARA"," STELARA ","1","Select","Select",""],["","","AZITHROMYCIN","TAB 500MG","","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","120","Select","Select",""],["","","DICYCLOMINE","TAB 20MG","","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","","MIRTAZAPINE","TAB 15MG","","Select","Select",""],["","","PROMETHAZINE","TAB 25MG","","Select","Select",""],["","","DRONABINOL","CAP 2.5MG","","Select","Select",""],["","","XULANE","DIS 150-35","","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":""}]}]}