{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M   EICARGDOOWLEZAH ","gend":1,"add":"XOB OP3701 ","city":"VICTORIA","state":"VA","zip":"23974-9998","dob":"1963-07-31","age":"","mstatus":"","insh":"98200210*74","cliId":"","pno":"08\/4341642-8","cno":"","email":"","ename":"","eno":"","pphy":"INGE, MARGARET DO","ppno":"434\/696-2165","pcpadd":"1508 K V RD","pcpcity":"VICTORIA","pcpstate":"VA","pcpzip":23974,"pcpcounty":"","pcpid":"","pcpname":"SOUTHERN DOMINION HEALTH SYSTEM INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","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":["J20.9","J44.9","J32.9","K21.9","G25.81","F17.299","J01.90","R05.","J01.00","Z11.59","L98.9","J45.901","J06.9","J02.9","H60.92","F17.200","Z72.0","R73.09","G62.9","R06.2","Z68.24"],"date":["2020-01-13","2021-02-10","2020-06-18","2021-02-10","2020-03-02","2020-03-02","2021-06-17","2021-06-17","2021-10-06","2021-10-06","2020-07-30","2021-02-05","2021-02-05","2021-02-05","2021-02-05","2021-02-10","2019-01-25","2019-01-25","2019-01-25","2019-11-18","2019-08-21"],"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":[["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","60505006501","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","","ROPINIROLE","TAB 0.25MG","","Select","Select",""],["","00093227534","AMOX\/K","TAB 875-125","20","Select","Select",""],["","64980047201","METAXALONE","TAB 800MG","60","Select","Select",""],["","16729017317","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","15","Select","Select",""],["","00713055593","DOXYCYC","CAP 100MG","14","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","14","Select","Select",""],["","64980051505","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","MUPIROCIN","OIN 0.02","","Select","Select",""],["","49483060650","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","","MUCINEX","TAB 1200MG","","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","42","Select","Select",""],["","08373747800","OPTICHAMBER","MIS DIAMOND","1","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":""}]}]}