{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ADNAMADRALLIW","gend":1,"add":"OB OP213 X","city":"BASSETT","state":"VA","zip":"24055-9998","dob":"1991-01-22","age":"","mstatus":"","insh":"8131210*01","cliId":"","pno":"08\/6723060-6","cno":"","email":"","ename":"","eno":"","pphy":"CLARK, RHONDA NP","ppno":"276\/647-5133","pcpadd":"2202 DANIELS CREEK RD","pcpcity":"COLLINSVILLE","pcpstate":"VA","pcpzip":24078,"pcpcounty":"","pcpid":"","pcpname":"TOTAL HEALTHCARE","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":["F32.1","F41.0","N93.9","R87.619","Z98.51","Z32.02","Z01.419","Z12.4","J06.9","R05.9","R50.9","N76.6","R30.0","F41.1","Z13.6","Z13.29","J02.0","R13.10","U07.1","J02.9","R11.2","B97.89","R05.","J11.1","Z71.89","Z71.3"],"date":["2021-04-07","2021-04-07","2021-05-11","2021-12-15","2021-05-11","2021-11-28","2021-04-07","2021-04-07","2021-11-26","2021-11-26","2021-11-26","2021-05-25","2021-05-25","2021-12-15","2021-12-15","2021-12-15","2021-09-15","2021-09-15","2021-11-28","2021-09-15","2021-11-28","2019-02-18","2019-03-13","2019-02-20","2019-02-20","2019-02-20"],"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":{"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":[["","","ALPRAZOLAM"," ALPRAZOLAM ","60","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","20","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","12","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","15","Select","Select",""],["","50419075401","CIPRO","TAB 500MG","12","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","10","Select","Select",""],["","00573018010","ADVIL","TAB SINUS","12","Select","Select",""],["","","TAMIFLU"," TAMIFLU ","10","Select","Select",""],["","","OSELTAMIVIR"," OSELTAMIVIR ","10","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","10","Select","Select",""],["","","TRIAMCINOLON"," TRIAMCINOLON ","17","Select","Select",""],["","","CITALOPRAM"," CITALOPRAM ","30","Select","Select",""],["","","NASAL"," NASAL ","17","Select","Select",""],["","","PROMETHAZINE"," PROMETHAZINE ","150","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":""}]}]}