{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NOHTANHOJNAMTOC D  ","gend":0,"add":"OP A TPA612 XOB ","city":"LIGHTFOOT","state":"VA","zip":"23090-9998","dob":"1998-03-29","age":"","mstatus":"","insh":"85200210*42","cliId":"","pno":"65\/7575519-1","cno":"757\/561-9155","email":"","ename":"","eno":"","pphy":"MAYER, BRUCE MD","ppno":"757\/566-2045","pcpadd":"7151 RICHMOND ROAD SUITE 403","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23188,"pcpcounty":"","pcpid":"","pcpname":"","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":["G89.18","K59.09","V54.16","V58.89","F17.210","J45.909","F41.9","F90.9","Z79.01","Z79.899","R10.13","R11.2","T84.9XXA","S82.141A","S49.81XA","S42.251A","S82.102A","M79.644","R69.","T14.90XA","M25.511","V89.9XXA","M24.311","Z74.01","S42.254A","S42.291A","S43.491A","V89.9XXD","R29.898","M25.661","M25.561","G89.29","S61.259A","S61.212A","W54.0XXA","S43.004A","M54.5"],"date":["2020-06-24","2020-06-26","2021-03-17","2022-08-22","2022-08-22","2020-07-02","2020-07-02","2022-08-22","2020-07-02","2020-07-02","2020-07-08","2020-07-08","2021-03-17","2020-09-19","2020-06-16","2020-09-19","2020-09-19","2022-08-22","2020-06-17","2020-06-17","2020-08-25","2020-06-17","2020-06-19","2020-06-25","2020-06-17","2020-07-13","2020-07-13","2020-07-13","2020-08-14","2020-08-14","2020-08-14","2020-08-25","2022-08-14","2022-08-14","2022-08-14","2020-06-18","2020-08-25"],"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":[["","66685101201","AMOX\/K","SUS 400\/5ML","150","Select","Select",""],["","69842093108","ACETAMINOPHN","TAB 500MG","90","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","47781019601","OXYCOD\/APAP","TAB 5-325MG","50","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","20","Select","Select",""],["","50458057990","XARELTO","TAB 20MG","25","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","67877031901","IBUPROFEN","TAB 400MG","30","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","18","Select","Select",""],["","00536106210","STOOL","CAP 100MG","50","Select","Select",""],["","42571014405","CELECOXIB","CAP 200MG","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","20","Select","Select",""],["","50428661736","CVS","CAP 25MG","24","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","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":""}]}]}