{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROY  E GRIFFEY","gend":0,"add":"PO BOX 104","city":"SALTVILLE","state":"VA","zip":"24370-9998","dob":"1980-09-17","age":"","mstatus":"","insh":"20028279*01","cliId":"","pno":"276\/780-7106","cno":"276\/780-7106","email":"","ename":"","eno":"","pphy":"","ppno":"","pcpadd":"","pcpcity":"","pcpstate":"","pcpzip":"","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.621","E11.65","D64.9","K21.9","F41.9","F32.9","L97.429","L03.116","E11.42","E11.51","M86.622","Z89.432","Z89.431","Z79.4","NO DATA","B95.62","F17.220","B95.1","I10.","F19.10","S91.011A","R94.5","R74.0","E83.39","E10.65","Z79.899","L97.529","Z48.817","Z72.0","F19.90","Z66.","F17.210","Z91.19","Z59.0","Z80.0","Z82.49","Z88.0","Z88.2","L02.31","M86.172","A49.01","L97.423"],"date":["2021-08-24","2020-05-08","2020-02-25","2020-05-08","2020-05-08","2020-05-08","2020-03-05","2020-05-08","2020-05-08","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-03-05","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-05-08","2020-01-15","2020-01-15","2020-02-24","2020-02-24","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2021-08-24","2021-08-24","2021-08-24","2021-08-24"],"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":[["","86227065105","INSULIN ","1ML\/31G","100","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","28","Select","Select",""],["","00088222033","LANTUS ","100\/ML","10","Select","Select",""],["","00002771559","BASAGLAR ","100UNIT","15","Select","Select",""],["","53885044801","ONETOUCH ","ULTRA 2","1","Select","Select",""],["","56151147002","TRUE ","METER","1","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","10","Select","Select",""],["","99073070822","FREESTYLE    TES LITE","LITE","100","Select","Select",""],["","65862018601","CLINDAMYCIN ","300MG","60","Select","Select",""],["","90166083152","PEN  NEEDLES  ","31GX8MM","100","Select","Select",""],["","0","","","4","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","53746027205","SMZ\/TMP ","800-160","14","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","8","Select","Select",""],["","68382075810","METFORMIN ","500MG","60","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","",""],["No","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":""}]}]}