{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSE   J NUCKOLS","gend":0,"add":"14320 NELSON HILLS ROAD","city":"MILFORD","state":"VA","zip":"22514-9998","dob":"1975-12-13","age":"","mstatus":"","insh":"900042505*01","cliId":"","pno":"804\/512-8292","cno":"703\/489-5863","email":"","ename":"","eno":"","pphy":"ESSAH, PAULINA A MD","ppno":"804\/798-9208","pcpadd":"STE C 306 ASHCAKE RD","pcpcity":"ASHLAND","pcpstate":"VA","pcpzip":23005,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS INTERNAL MEDICINE OF ASHLAND","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/798-8108","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N30.00","R05.9","Z46.82","G40.909","Z20.822","R56.9","R13.10","K21.9","G40.89","N39.0","J30.9","R06.2","T17.928A","Z98.890","Z43.1","N39.46","L22.","R39.81","Z93.1","G82.20","Z74.09","F79.","J45.20","G40.209","Z99.3","Z00.00","Z13.31","E46.","K94.23","J45.909","Z87.440","Z79.51","Z79.899","R82.998","H61.23","G25.81"],"date":["2021-03-09","2021-11-03","2021-10-10","2021-12-22","2021-12-22","2021-12-22","2021-11-18","2021-11-18","2021-11-18","2021-06-28","2021-11-03","2021-11-03","2021-11-03","2021-11-03","2021-08-20","2021-10-21","2021-10-21","2021-10-21","2021-10-21","2021-10-21","2021-10-21","2021-06-18","2021-06-17","2021-06-24","2021-06-18","2021-02-23","2021-02-23","2021-02-23","2021-10-10","2021-10-10","2021-10-10","2021-10-10","2021-10-10","2021-05-28","2021-05-28","2021-06-24"],"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":[]}]},{"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":[["","76204020060","ALBUTEROL SULFATE                                                     ","0.08%","360","Select","Select",""],["","62756022483","TIAGABINE HYDROCHLORIDE                                               ","4MG","510","Select","Select",""],["","00131248035","VIMPAT                                                                ","200MG","30","Select","Select",""],["","00172572860","FAMOTIDINE                                                            ","20MG","180","Select","Select",""],["","43547026910","ROPINIROLE HCL                                                        ","0.5MG","90","Select","Select",""],["","00121067516","VALPROIC ACID                                                         ","250\/5ML","2727","Select","Select",""],["","50383024116","LEVETIRACETAM                                                         ","100MG\/ML","2700","Select","Select",""],["","57237005920","CEFUROXIME AXETIL                                                     ","500MG","-14","Select","Select",""],["","00574200802","NYSTOP                                                                ","100000","60","Select","Select",""],["","13811071910","NITROFURANTOIN MONOHYDRATE\/MACROCRYSTALS                              ","100MG","10","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS                                      ","800-160","-14","Select","Select",""],["","00338004304","SODIUM CHLORIDE 0.45%                                                 ","0.45%","-84000","Select","Select",""],["","00143992801","CIPROFLOXACIN HYDROCHLORIDE                                           ","500MG","-10","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}