{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTOPHER RODGERS","gend":0,"add":"507 E ATLANTIC ST APT 4","city":"EMPORIA","state":"VA","zip":"23847-9998","dob":"1974-03-15","age":"","mstatus":"","insh":"1709336*01","cliId":"","pno":"252\/532-7073","cno":"252\/532-7073","email":"","ename":"","eno":"","pphy":"FELDMANN, SPENCER MD","ppno":"","pcpadd":"511 BELFIELD DRIVE","pcpcity":"EMPORIA","pcpstate":"VA","pcpzip":23847,"pcpcounty":"","pcpid":208807,"pcpname":"SOUTHSIDE PHYSICIANS NETWORK - FAMILY MEDICINE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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":["F33.3","M16.12","M25.552","M25.562","M25.572","M25.472","Z78.9","M76.62","F33.1","R19.09","G89.29","Z68.28","K21.9","S76.012A","M17.12","F33.0","M79.652","R59.0","Z11.3","Z68.26","M17.0"],"date":["2020-09-15","2021-06-25","2021-06-07","2021-06-07","2021-07-12","2021-08-16","2021-07-12","2021-08-16","2020-09-21","2021-01-22","2021-06-07","2021-01-22","2021-01-22","2020-02-12","2021-06-25","2020-11-04","2021-03-09","2021-02-12","2021-02-12","2021-06-07","2021-06-25"],"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":[["","68645049254","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","65162019011","NAPROXEN ","500MG","60","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG","90","Select","Select",""],["","00406048410","APAP\/CODEINE ","300-30MG","12","Select","Select",""],["","57664037718","TRAMADOL ","50MG","21","Select","Select",""],["","68645056354","IBUPROFEN ","800MG","20","Select","Select",""],["","42806040021","METHYLPRED ","4MG","21","Select","Select",""],["","16571020150","DICLOFENAC ","75MG DR","60","Select","Select",""],["","68645049254","PANTOPRAZOLE","40MG","30","Select","Select",""],["","65162019011","NAPROXEN","500MG","60","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG","90","Select","Select",""],["","00406048410","APAP\/CODEINE","300-30MG","12","Select","Select",""],["","16571020150","DICLOFENAC","75MG DR","60","Select","Select",""],["","42806040021","METHYLPRED","4MG","21","Select","Select",""],["","68645056354","IBUPROFEN","800MG","20","Select","Select",""],["","57664037718","TRAMADOL","50MG","21","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}