{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   MAILLIWSREYLAS M","gend":0,"add":"FRON 473EVA KLO","city":"BRISTOL","state":"VA","zip":"24201-9998","dob":"1982-03-22","age":"","mstatus":"","insh":"9185110*21","cliId":"","pno":"46\/6726791-4","cno":"276\/644-1976","email":"","ename":"","eno":"","pphy":"ANDREWS, ROY R DO","ppno":"276\/669-5179","pcpadd":"2195 EUCLID AVE","pcpcity":"BRISTOL","pcpstate":"VA","pcpzip":24201,"pcpcounty":"","pcpid":"","pcpname":"","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":["R07.89","R91.1","I10.","R00.2","F41.9","F33.1","F41.1","F17.200","R10.816","K21.9","R10.12","Z23.","K76.0","Z01.812","L03.116","L03.115","R06.00","M79.669","M79.89","R07.9","R07.2","J98.4","N50.9","R39.89"],"date":["2021-12-02","2022-05-11","2022-05-11","2021-12-02","2022-11-22","2022-11-22","2022-05-11","2022-05-11","2020-09-23","2022-05-11","2020-09-23","2020-09-23","2022-05-11","2020-02-04","2020-06-10","2020-06-17","2020-06-18","2020-07-02","2020-07-02","2022-05-11","2020-05-26","2020-06-18","2021-01-20","2021-01-20"],"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":[]},{"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":[["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","30","Select","Select",""],["","43547028210","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","00781107810","ATENOLOL","TAB 25MG","60","Select","Select",""],["","43598044874","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","57237023301","SMZ-TMP","TAB 800-160","42","Select","Select",""],["","68462063945","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","62175013643","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00143980350","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","14","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","00781502207","METHYLPRED","TAB 4MG","21","Select","Select",""],["","43547040110","FUROSEMIDE","TAB 20MG","15","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":""}]}]}