{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NHOJSLLEW","gend":0,"add":"LC 705TS YA","city":"CLIFTON FORGE","state":"VA","zip":"24422-9998","dob":"1974-08-06","age":"","mstatus":"","insh":"8851210*44","cliId":"","pno":"68\/0452231-2","cno":"540\/862-1322","email":"","ename":"","eno":"","pphy":"HENDERSON, ROBERT J DO","ppno":"540\/862-6750","pcpadd":"SUITE 800 200 ARH LANE","pcpcity":"COVINGTON","pcpstate":"VA","pcpzip":24426,"pcpcounty":"","pcpid":"","pcpname":"","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D44.4","E27.49","E03.8","E23.0","E29.1","E23.2","R20.2","F17.200","K21.9","R07.9","E78.2","R10.9","G62.9","Z13.220","N41.9","E55.9","R53.1","N41.1","R39.14","N32.9","M79.641","M79.642","M79.631","M79.632","R20.0","G56.00","Z23."],"date":["2021-10-28","2021-10-28","2021-10-28","2021-10-28","2022-07-11","2021-10-28","2021-05-03","2022-01-18","2022-01-18","2022-01-18","2021-10-28","2022-01-18","2020-12-15","2020-10-06","2020-01-07","2020-12-15","2020-01-07","2022-07-11","2022-07-11","2021-01-09","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-10-28"],"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":[["","00023599230","ANDRODERM","DIS 4MG\/24HR","180","Select","Select",""],["","00169770421","NORDITROPIN","INJ 5\/1.5ML","2","Select","Select",""],["","69918020101","DESMOPRESSIN","TAB 0.2MG","60","Select","Select",""],["","42543014101","HYDROCORT","TAB 10MG","45","Select","Select",""],["","31722071290","PANTOPRAZOLE","TAB 20MG","60","Select","Select",""],["","00781518410","LEVOTHYROXIN","TAB 100MCG","90","Select","Select",""],["","43386033001","TRIMETHOPRIM","TAB 100MG","30","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","45802075401","TESTOSTERONE","GEL 0.0162","75","Select","Select",""],["","68382013210","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","60","Select","Select",""],["","67877046990","PREGABALIN","CAP 300MG","60","Select","Select",""],["","69097081307","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","50242007501","NUTROPIN","INJ NUSPIN 5","2","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","08290305426","SHARPS","MIS 5.4QT","1","Select","Select",""],["","00781183120","AMOX\/K","TAB 500-125","60","Select","Select",""],["","27241011203","TADALAFIL","TAB 5MG","90","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","24208050707","LOTEMAX","GEL 0.0038","5","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","60","Select","Select",""],["","00071101568","LYRICA","CAP 100MG","60","Select","Select",""],["","49348089610","SM","PAD PREP","100","Select","Select",""],["","13668018590","SILDENAFIL","TAB 20MG","50","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}