{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TINA   R BOOKER","gend":1,"add":"7006 GITTINGS CT","city":"MECHANICSVILLE","state":"VA","zip":"23111-9998","dob":"1968-06-05","age":"","mstatus":"","insh":"1715680*01","cliId":"","pno":"434\/607-1049","cno":"434\/607-1049","email":"","ename":"","eno":"","pphy":"BONAGIRI, VARA MD","ppno":"434\/392-9000","pcpadd":"1400 MILNWOOD ROAD","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":23901,"pcpcounty":"","pcpid":118538,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"434\/607-1841","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":["F41.1","Z30.42","F33.2","F33.1","F43.12","M25.561","M54.2","M62.838","G89.29","Z68.38","F43.10","Z32.02","K21.9","Z00.00","E66.01","Z68.37","M17.11","Z01.411","Z11.3","A54.9","N39.41","N39.3"],"date":["2021-08-12","2020-09-11","2021-07-06","2021-10-08","2021-07-06","2021-04-08","2021-03-24","2021-03-24","2021-03-24","2021-04-08","2021-10-08","2021-08-02","2021-09-14","2021-01-27","2021-01-27","2021-01-27","2021-05-28","2021-08-02","2021-08-02","2021-08-09","2021-09-17","2021-09-17"],"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":[["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE ","40MG","30","Select","Select",""],["","68382014005","TOPIRAMATE ","100MG","30","Select","Select",""],["","62332003831","LAMOTRIGINE ","100MG","60","Select","Select",""],["","00093719801","FLUOXETINE ","40MG","60","Select","Select",""],["","50111044101","TRAZODONE ","150MG","30","Select","Select",""],["","00115180401","HYDROXYZ ","50MG","60","Select","Select",""],["","00378230201","PRAZOSIN ","2MG","60","Select","Select",""],["","00115165901","PROPRANOLOL ","10MG","60","Select","Select",""],["","65862001305","SERTRALINE ","100MG","30","Select","Select",""],["","67877043103","ARIPIPRAZOLE ","5MG","90","Select","Select",""],["","00781320785","CEFTRIAXONE ","500MG","1","Select","Select",""],["","55111017915","TIZANIDINE ","2MG","15","Select","Select",""],["","16729013716","CLONAZEPAM ","1MG","60","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","10","Select","Select",""],["","29300011201","LAMOTRIGINE","100MG","60","Select","Select",""],["","68382014005","TOPIRAMATE","100MG","30","Select","Select",""],["","00115180401","HYDROXYZ","50MG","60","Select","Select",""],["","50111044101","TRAZODONE","150MG","30","Select","Select",""],["","00093719801","FLUOXETINE","40MG","60","Select","Select",""],["","68462039710","OMEPRAZOLE","40MG","30","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","00378110101","PRAZOSIN","1MG","60","Select","Select",""],["","55111017915","TIZANIDINE","2MG","15","Select","Select",""],["","00115165901","PROPRANOLOL","10MG","60","Select","Select",""],["","65862001205","SERTRALINE","50MG","30","Select","Select",""],["","13668021730","ARIPIPRAZOLE","5MG","30","Select","Select",""],["","16729013716","CLONAZEPAM","1MG","60","Select","Select",""],["","00781320785","CEFTRIAXONE","500MG","1","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","10","Select","Select",""],["","00069024230","TOVIAZ","4MG","30","Select","Select",""],["","59148003713","REXULTI","1MG","30","Select","Select",""],["","59148003713","REXULTI ","TAB 1MG","30","Select","Select",""],["","00069024230","TOVIAZ ","TAB 4MG","30","Select","Select",""],["","42192080201","PHENAZOPYRID ","TAB 200MG","9","Select","Select",""],["","68462011940","FLUCONAZOLE ","TAB 150MG","1","Select","Select",""],["","69238116609","DOXEPIN ","CAP 10MG","30","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","",""],["Yes","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":""}]}]}