{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALINE DEMBO","gend":1,"add":"1131 LOUDON AVE NW","city":"ROANOKE","state":"VA","zip":"24017-9998","dob":"1980-12-03","age":"","mstatus":"","insh":"20026431*01","cliId":"","pno":"540\/278-5440","cno":"540\/278-5440","email":"","ename":"","eno":"","pphy":"HIPPEARD, SCOTT C MD","ppno":"540\/774-4000","pcpadd":"4806 PLEASANT HILL DR STE 203","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24018,"pcpcounty":"","pcpid":210355,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/400-6890","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N93.9","R00.2","R53.1","R07.9","M54.2","O99.89","R10.2","Z3A.08","M54.12","B20.","R10.9","Z23.","R29.898","R10.13","Z01.419","Z12.4","K08.89","K02.9","M43.6","G44.89","R51.9","Z78.9","N76.0","Z21.","R10.30"],"date":["2020-01-17","2020-01-17","2020-01-17","2020-01-17","2021-01-14","2020-01-06","2020-01-06","2020-01-06","2021-01-12","2021-10-19","2020-01-06","2021-10-14","2020-11-18","2020-11-18","2021-07-09","2021-07-09","2021-05-26","2021-05-26","2020-11-10","2021-10-19","2021-10-19","2021-10-19","2021-10-08","2021-10-08","2021-10-08"],"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":[["","61958250101","BIKTARVY ","","30","Select","Select",""],["","00378064205","PREDNISONE ","20MG","20","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","15","Select","Select",""],["","60505025203","TIZANIDINE ","4MG","30","Select","Select",""],["","69097015907","MELOXICAM ","15MG","15","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","16571020106","DICLOFENAC ","75MG DR","20","Select","Select",""],["","00093117410","PENICILLN ","500MG","30","Select","Select",""],["","10702001801","OXYCODONE ","5MG","12","Select","Select",""],["","61958250101","BIKTARVY","","30","Select","Select",""],["","00378064205","PREDNISONE","20MG","20","Select","Select",""],["","69097015907","MELOXICAM","15MG","15","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","60505025203","TIZANIDINE","4MG","60","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","15","Select","Select",""],["","00093117410","PENICILLN","500MG","30","Select","Select",""],["","10702001801","OXYCODONE","5MG","12","Select","Select",""],["","16571020106","DICLOFENAC","75MG DR","20","Select","Select",""],["","49483060450","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","62756052169","SUMATRIPTAN ","TAB 50MG","9","Select","Select",""],["","50111033401","METRONIDAZOL ","TAB 500MG","14","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","",""],["No","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":""}]}]}