{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   YRREHSYESDOG A","gend":1,"add":"DUM 15541DAOR KROF","city":"FALLS MILLS","state":"VA","zip":"24613-9998","dob":"1973-03-04","age":"","mstatus":"","insh":"97200210*23","cliId":"","pno":"23\/6729171-2","cno":"276\/970-2491","email":"","ename":"","eno":"","pphy":"BILLIPS, RONALD W MD","ppno":"304\/431-5499","pcpadd":"3997 BECKLEY ROAD","pcpcity":"PRINCETON","pcpstate":"WV","pcpzip":24740,"pcpcounty":"","pcpid":"","pcpname":"BLUESTONE HEALTH ASSOCIATION","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["R39.81","M05.9","N39.46","J44.9","G93.9","K21.9","G60.3","J31.0","S61.411A","H16.223","H30.92","B07.0","R06.02","R10.84","L98.9","Z20.828","L02.31","R92.8","M20.42","L85.1","I73.9","M20.60","R09.89"],"date":["2022-05-24","2022-05-24","2022-05-24","2021-12-03","2022-05-24","2021-12-03","2021-12-03","2021-12-03","2020-06-22","2020-09-28","2020-09-28","2021-01-07","2021-12-03","2021-12-03","2020-09-22","2021-11-03","2021-04-10","2019-09-03","2019-08-19","2019-08-19","2022-06-06","2022-05-04","2022-06-06"],"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":[["","00173069500","ADVAIR","AER 100\/50","60","Select","Select",""],["","00781223410","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","","ARTIFICIAL","SOL TEARS","","Select","Select",""],["","00487950103","ALBUTEROL","NEB 0.00083","180","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65862052305","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","00378932032","WIXELA","AER 100\/50","60","Select","Select",""],["","66993058497","FLUTIC\/SALME","AER 100\/50","60","Select","Select",""],["","51660052601","ALLERGY","TAB 10MG","30","Select","Select",""],["","70000050201","DRY","DRO ","15","Select","Select",""],["","65862019299","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","49884029001","MEGESTROL","TAB 40MG","60","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","5","Select","Select",""],["","00065806301","GENTEAL","SOL MOD PF","36","Select","Select",""],["","57664037718","TRAMADOL","TAB 50MG","10","Select","Select",""],["","53746027205","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","45802065065","LORATADINE","TAB 10MG","30","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","ATROPINE","SOL 1% OP","","Select","Select",""],["","","DEXAMETH","SOL 0.1% OP","","Select","Select",""],["","","ISOPTO","SOL 1% OP","","Select","Select",""],["","00781577626","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00603158658","PROMETHAZINE","SOL DM","150","Select","Select",""],["","70000030201","COUGH","SUS 30MG\/5ML","89","Select","Select",""],["","10119002010","MOISTURE","DRO ","30","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":""}]}]}