{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   HTENNEKREKATIHW J","gend":0,"add":"DR3 001ES TS ","city":"PULASKI","state":"VA","zip":"24301-9998","dob":"1992-10-23","age":"","mstatus":"","insh":"9851210*93","cliId":"","pno":"75\/0459293-7","cno":"540\/577-3929","email":"","ename":"","eno":"","pphy":"REBKOVICH, KELLY NICOLE DO","ppno":"540\/674-4560","pcpadd":"4550 LEE HIGHWAY SUITE B","pcpcity":"DUBLIN","pcpstate":"VA","pcpzip":24084,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","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":["N20.0","N13.30","N18.9","G47.33","R73.03","I10.","E78.2","NO DATA","E55.9","Z23.","N13.2","R10.9","R50.9","Z01.810","N20.1","Z46.6","N13.5","N28.9","R79.89","B07.9","R40.0","K04.7","Z20.822","M65.332","X50.3XXA","Z96.0","R82.90","K08.89","R80.9","D63.1","J44.9","R74.8","S37.10XA","R20.2","E78.00","R21.","E87.5","I51.7","R94.31"],"date":["2022-09-06","2022-05-19","2022-05-13","2022-07-21","2022-07-21","2022-09-06","2022-07-21","2022-09-06","2021-12-02","2021-12-02","2020-03-25","2020-03-23","2020-03-23","2020-04-28","2020-04-28","2022-05-11","2022-05-11","2021-08-12","2021-08-12","2020-07-24","2020-07-24","2020-10-11","2021-09-05","2022-04-05","2022-04-05","2020-04-28","2020-04-27","2020-10-11","2022-09-06","2022-09-06","2020-03-23","2020-04-28","2020-04-28","2021-08-12","2021-08-12","2020-02-17","2020-02-17","2022-05-13","2022-05-13"],"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":[["","00406055201","OXYCODONE","TAB 5MG","10","Select","Select",""],["","31722088390","ROSUVASTATIN","TAB 10MG","30","Select","Select",""],["","64980043710","ATENOLOL","TAB 25MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","9","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","70954000520","OXYBUTYNIN","TAB 5MG","14","Select","Select",""],["","51293081001","PHENAZOPYRID","TAB 100MG","21","Select","Select",""],["","69543013611","TRAMADOL","TAB 50MG","45","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","00168000215","TRIAMCINOLON","CRE 0.005","60","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","10","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","10","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","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":""}]}]}