{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM   T COX","gend":0,"add":"1403 HIGH PLACE LN","city":"BLUE RIDGE","state":"VA","zip":"24064-9998","dob":"1961-03-09","age":"","mstatus":"","insh":"1880776*01","cliId":"","pno":"540\/947-5850","cno":"540\/947-5850","email":"","ename":"","eno":"","pphy":"ERNST, BENJAMIN DAVID DO","ppno":"540\/265-5500","pcpadd":"6415 PETERS CREEK RD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24019,"pcpcounty":"","pcpid":147705,"pcpname":"","plan":"OHP","program":"ACA","lob":"Small Group","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"540\/819-5850","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":["I47.1","R06.02","Z23.","E78.5","Z00.00","E34.9","N52.9","F41.9","J30.89","G25.81","B35.1","L03.811","M53.3","Z12.11","H93.8X3","J34.89","J34.3","H69.83","H69.80","H93.13","H90.3","H92.03","E11.9","Z79.82","L02.811","L02.91"],"date":["2020-08-14","2020-08-14","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2020-09-10","2021-06-14","2021-06-14","2020-08-31","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-01-10","2020-05-26","2020-05-26","2020-05-26","2020-05-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","62756001540","TESTOST","200MG\/ML","2","Select","Select",""],["","51525029403","AZELASTINE","0.10%","30","Select","Select",""],["","16729013600","CLONAZEPAM","0.5MG","30","Select","Select",""],["","00378427693","VALACYCLOVIR","1GM","21","Select","Select",""],["","00527155201","BUT\/ASA\/CAFF","","30","Select","Select",""],["","57237011490","ALFUZOSIN","10MG ER","90","Select","Select",""],["","68382005101","MELOXICAM","15MG","-30","Select","Select",""],["","69547035302","NARCAN","","-2","Select","Select",""],["","00591234101","METAXALONE","800MG","60","Select","Select",""],["","68001024604","ONDANSETRON","4MG ODT","10","Select","Select",""],["","00406012301","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","53489011905","DOXYCYCL","100MG","20","Select","Select",""],["","65862007930","TERBINAFINE","250MG","90","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","32","Select","Select",""],["","65862001401","AMOXICILLIN","500MG","20","Select","Select",""],["","62756001540","TESTOST ","200MG\/ML","2","Select","Select",""],["","51525029403","AZELASTINE ","0.10%","30","Select","Select",""],["","00591321901","BUT\/ASA\/CAFF ","","30","Select","Select",""],["","16729013600","CLONAZEPAM ","0.5MG","30","Select","Select",""],["","68382005101","MELOXICAM ","15MG","30","Select","Select",""],["","00378427693","VALACYCLOVIR ","1GM","21","Select","Select",""],["","53489011905","DOXYCYCL ","100MG","20","Select","Select",""],["","57237011490","ALFUZOSIN ","10MG ER","90","Select","Select",""],["","65862007930","TERBINAFINE ","250MG","90","Select","Select",""],["","00591234101","METAXALONE ","800MG","-60","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","65862001401","AMOXICILLIN ","500MG","20","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","68001024604","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","00093314705","CEPHALEXIN ","500MG","32","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}