{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SCOTT   J HILL","gend":0,"add":"6649 CANEY RIDGE ROAD","city":"COEBURN","state":"VA","zip":"24230-9998","dob":"1957-05-23","age":"","mstatus":"","insh":"20029190*01","cliId":"","pno":"276\/395-2995","cno":"276\/395-2995","email":"","ename":"","eno":"","pphy":"BEVINS, ASHLEY DO","ppno":"276\/328-8910","pcpadd":"716 SPRING AVE SE SUITE 204","pcpcity":"WISE","pcpstate":"VA","pcpzip":24293,"pcpcounty":"","pcpid":152191,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/328-4318","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K92.0","H35.3133","H43.813","H25.13","K85.20","K76.6","E87.1","K70.30","K29.20","F10.229","Z91.19","I10.","K76.0","I25.10","R59.0","F17.210","I25.2","N40.0","D69.6","R19.7","K92.2","R07.9","F10.129","M21.922","S41.112A","V86.55XA","S22.32XA","S42.102A","S32.130A","S32.2XXA","S22.42XA","S32.10XA","J44.9","F03.90","F10.10","Z88.0","R00.0","Z72.89","R40.2410","W19.XXXA","S51.822A","R93.1","F10.20","K63.89","M85.88","K21.9","Z79.899","S29.9XXA","I51.3","S22.41XA","R10.30","R00.1","I23.6","S56.822A","S42.112A","S32.111A","Z87.81"],"date":["2020-03-10","2020-02-14","2020-02-14","2020-02-14","2020-03-09","2020-03-09","2021-11-15","2020-03-09","2020-03-09","2020-03-09","2020-03-09","2021-11-12","2020-03-09","2021-11-12","2020-03-09","2021-11-12","2021-11-12","2021-11-12","2020-03-09","2020-03-09","2020-03-08","2020-03-09","2020-03-08","2021-09-02","2021-09-02","2021-09-02","2021-11-11","2021-11-15","2021-11-11","2021-11-11","2021-11-15","2021-11-15","2021-11-12","2021-11-12","2021-11-15","2021-11-12","2021-11-14","2021-11-14","2021-11-14","2021-11-15","2021-09-02","2021-09-02","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-09-03","2021-11-12","2021-11-12","2021-09-02","2021-09-02","2021-09-02","2021-11-12","2021-11-12","2021-11-12"],"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":[["","59762040101","SUCRALFATE ","1GM","56","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","30","Select","Select",""],["","59762040101","SUCRALFATE","1GM","56","Select","Select",""],["","50458057930","XARELTO","20MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","30","Select","Select",""],["","50458057930","XARELTO ","TAB 20MG","30","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","TAB 5-325MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP ","TAB 5-325MG","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","",""],["Yes","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":""}]}]}