{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"IUNAMMEUKUK L","gend":0,"add":"B B 502TS DAOR","city":"BRIDGEWATER","state":"VA","zip":"22812-9998","dob":"1961-01-01","age":"","mstatus":"","insh":"0064210*69","cliId":"","pno":"1204551704","cno":5402140715,"email":"","ename":"","eno":"","pphy":"BEERS, KYMBER NP","ppno":5404334913,"pcpadd":"1380 LITTLE SORRELL DR STE 100","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":"22801-9998","pcpcounty":"","pcpid":"","pcpname":"Healthy Community Health Center - Stone Port (HCHC-Stone Port)","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M17.11","M22.42","Z79.899","I10.","M25.562","Z01.89","Z12.11","R21.","M54.6","Z23.","M10.9","R50.9","S83.241A","I49.1","I49.3","M19.071","V58.89","NO DATA","M10.071","M25.561","Z76.89","G89.29","Z00.00","E78.2","M25.572","S39.012A","M51.36","I49.9","E78.5","K21.9","M79.671","E11.9"],"date":["2023-03-01","2022-06-01","2022-10-17","2022-10-17","2022-11-20","2022-09-21","2022-09-21","2022-09-21","2022-09-21","2022-09-21","2023-01-27","2022-10-17","2022-10-28","2022-02-10","2022-02-10","2023-01-18","2023-03-31","2023-03-31","2022-06-29","2023-03-01","2022-07-20","2022-08-31","2022-08-31","2022-08-31","2022-08-31","2023-01-30","2023-01-30","2022-02-10","2022-02-10","2022-02-10","2022-10-25","2023-01-18"],"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":[["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","68382009205","CARVEDILOL","3.125 MG","180","Select","Select",""],["","70010000201","COLCHICINE","0.6 MG","90","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","31722054201","INDOMETHACIN","CAP 25MG","15","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","120","Select","Select",""],["","50580022824","BENADRYL","CAP 25MG","30","Select","Select",""],["","68645055354","LISINOPRIL","20 MG","90","Select","Select",""],["","00904530660","BANOPHEN","25 MG","25","Select","Select",""],["","16714004107","ALLOPURINOL","100 MG","90","Select","Select",""],["","49035013606","EQ LIDOCAINE","PAD 0.04","6","Select","Select",""],["","68462029817","CLOTRIM\/BETA","CRE DIPROP","30","Select","Select",""],["","41167005723","ASPERCREME","CRE 0.1","35","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","200","Select","Select",""],["","49035090112","ALLERGY RELIEF","25 MG","30","Select","Select",""],["","69842097417","DICLOFENAC SODIUM","1 %","50","Select","Select",""],["","67877056110","METFORMIN HCL","500 MG","360","Select","Select",""],["","00832105415","BACLOFEN","10 MG","90","Select","Select",""],["","00093505998","ATORVASTATIN CALCIUM","20 MG","90","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":""}]}]}