{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AJNOSENOB ","gend":1,"add":"ELPAM 313RD FAEL ","city":"BLUEFIELD","state":"VA","zip":"24605-9998","dob":"1966-12-31","age":"","mstatus":"","insh":"8021210*01","cliId":"","pno":"88\/4036462-7","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":["H40.31X1","I10.","M25.552","F33.1","NO DATA","Z91.09","Z71.3","Z71.82","Z68.41","H10.9","M77.8","F41.1","E78.2","M25.512","G89.29","M76.892","M62.81","E78.5","R73.03","H40.9","M25.522","M47.819","M54.5","V58.89","H40.1131","F41.9","Z12.39","R19.7","H40.31X3","H40.1121","S49.92XA","M79.622","H65.191","M77.9","J01.90","B96.89","N39.0","M10.9","U07.1","J02.0","Z20.828","J01.10","R11.0","R10.13","H00.011","H10.31","Z12.9","M70.62","M47.22","S46.312A","R30.0","M25.622","M54.6","R06.02","M19.012","M75.82","M75.122","M75.22","Z13.31","Z68.39","R20.8","S39.012A","R10.31","Y93.9","Z68.38","M25.612","Z98.890","Z91.19","Z87.440","R51.","M79.641","S69.91XA","H66.001","K52.9","R10.84","R35.0","H04.123","H52.12","H27.01","M25.572","W19.XXXA","Z47.89","F32.2","R10.12","Z86.69","H65.21"],"date":["2020-08-06","2021-11-08","2021-08-04","2021-11-08","2020-03-09","2020-06-10","2021-11-08","2021-11-08","2021-11-08","2021-10-14","2021-04-21","2021-08-11","2021-11-08","2021-02-08","2021-02-08","2020-02-18","2020-11-19","2020-06-10","2020-06-10","2020-06-10","2020-11-19","2020-11-03","2020-09-14","2020-11-24","2021-06-08","2021-11-08","2021-08-04","2021-10-14","2021-12-08","2021-12-08","2020-08-12","2020-08-12","2021-05-26","2021-05-26","2021-07-21","2021-07-21","2021-08-25","2020-06-10","2020-12-30","2020-12-30","2020-12-30","2020-12-30","2020-12-30","2020-10-31","2020-11-18","2021-08-16","2021-11-08","2020-04-20","2021-04-21","2020-08-18","2020-09-28","2020-11-19","2020-07-30","2021-05-05","2019-04-23","2019-02-21","2019-02-21","2019-02-21","2019-10-17","2019-05-07","2019-05-07","2019-05-17","2019-05-17","2019-05-17","2019-01-03","2019-03-11","2019-02-07","2019-06-04","2019-06-04","2019-08-14","2019-10-31","2019-10-31","2019-09-04","2019-09-04","2019-09-04","2019-05-22","2019-08-01","2019-08-01","2019-08-01","2019-12-30","2019-12-30","2019-01-10","2019-04-09","2019-04-09","2019-04-09","2019-10-17"],"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":[["","","PAROXETINE","TAB 10MG","","Select","Select",""],["","65862020330","LOSARTAN","TAB 100MG","30","Select","Select",""],["","57664047752","METOPROL","TAB 50MG","60","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","45","Select","Select",""],["","00023917705","ALPHAGAN","SOL 0.0015","5","Select","Select",""],["","00115180401","HYDROXYZ","CAP 50MG","40","Select","Select",""],["","","TOBRAMYCIN","SOL 0.3% OP","","Select","Select",""],["","64980051305","TIMOLOL","SOL 0.25% OP","5","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","68001024617","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","61314014405","BRIMONIDINE","SOL 0.0015","5","Select","Select",""],["","57237009960","CEFDINIR","CAP 300MG","14","Select","Select",""],["","69238111806","BUSPIRONE","TAB 15MG","90","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","16729018217","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","68462019001","NAPROXEN","TAB 500MG","14","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","51525029403","AZELASTINE","SPR 0.001","30","Select","Select",""],["","63304082890","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","69543010750","DESLORATADIN","TAB 5MG","30","Select","Select",""],["","","ALLOPURINOL","TAB 100MG","","Select","Select",""],["","","POLYMYXIN","SOL TRIMETHP","","Select","Select",""],["","69367016204","PHENAZOPYRID","TAB 100MG","12","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","","SULFACET","SOL 10% OP","","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","42195055014","CIPROFLOXACN","SOL 0.002","14","Select","Select",""],["","57237002901","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","49281040020","ADACEL","INJ ","0","Select","Select",""],["","57237000430","FLUCONAZOLE","TAB 100MG","3","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","60505036302","OFLOXACIN","DRO 0.3%OTIC","10","Select","Select",""],["","62037059790","CARTIA","CAP 120\/24HR","21","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00143980350","DOXYCYCL","CAP 100MG","20","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":""}]}]}