{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YENTIHWSMAILLIW","gend":1,"add":"NOMSAR 8833B TPA DR T","city":"ROANOKE","state":"VA","zip":"24018-9998","dob":"1998-03-01","age":"","mstatus":"","insh":"9222210*21","cliId":"","pno":"98\/0452158-2","cno":"","email":"","ename":"","eno":"","pphy":"KEILMAN, DAVID MD","ppno":"540\/265-1607","pcpadd":"4910 VALLEY VIEW BLVD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":"24012","pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","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":["R42.","T14.90XA","R69.","R10.2","Z30.431","R11.2","R19.7","Z20.822","F41.8","E66.9","F43.10","Z79.899","Z71.3","O10.92","O23.43","Z37.0","O69.81X0","O99.344","O99.62","O70.1","O99.214","F41.9","Z3A.38","Z79.82","Z88.1","O16.4","Z01.419","N76.0","E66.01","Z68.43","R10.32","N39.0"],"date":["2021-01-18","2020-08-17","2020-08-17","2021-03-03","2021-03-03","2021-03-07","2021-03-07","2021-03-07","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2021-04-26","2021-04-26","2021-05-21","2021-05-21","2021-03-03","2021-03-03"],"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":[["","50111064701","FLUOXETINE","CAP 10MG","90","Select","Select",""],["","00574722612","COMPRO","SUP 25MG","10","Select","Select",""],["","64980030550","DENTA","CRE PLUS","153","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","90","Select","Select",""],["","00228202750","ALPRAZOLAM","TAB 0.25MG","60","Select","Select",""],["","00093321205","CLONAZEPAM","TAB 1MG","60","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","5","Select","Select",""],["","65162044210","MECLIZINE","TAB 25MG","30","Select","Select",""],["","65862022701","LAMOTRIGINE","TAB 25MG","270","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","60","Select","Select",""],["","49884012201","LABETALOL","TAB 100MG","270","Select","Select",""],["","10702002501","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","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":""}]}]}