{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HUNTER   T WADE","gend":0,"add":"APT F5 PO BOX 89","city":"SELMA","state":"VA","zip":"24474-9998","dob":"2003-11-12","age":"","mstatus":"","insh":"2131308*01","cliId":"","pno":"540\/862-5318","cno":"540\/862-5318","email":"","ename":"","eno":"","pphy":"MONROE, JULIE DO","ppno":"540\/962-1122","pcpadd":"322 W RIVERSIDE ST","pcpcity":"COVINGTON","pcpstate":"VA","pcpzip":24426,"pcpcounty":"","pcpid":146405,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","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":["F33.1","J02.9","Z71.9","F41.9","J06.9"],"date":["2020-04-21","2020-03-04","2021-07-27","2021-07-27","2021-09-09"],"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":[["","55111015030","FLUOXETINE ","10MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00603533815","PREDNISONE ","10MG","21","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","30","Select","Select",""],["","68382024705","BENZONATATE ","100MG","15","Select","Select",""],["","10006070127","VITAMIN ","125MCG","90","Select","Select",""],["","42806066305","BUSPIRONE ","10MG","40","Select","Select",""],["","59746011506","PROCHLORPER ","10MG","30","Select","Select",""],["","65162019050","NAPROXEN ","500MG","30","Select","Select",""],["","13668001105","CITALOPRAM ","40MG","30","Select","Select",""],["","55111015030","FLUOXETINE","10MG","30","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","50111078751","AZITHROMYCIN","250MG","6","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","68382024705","BENZONATATE","100MG","15","Select","Select",""],["","10006070127","VITAMIN","125MCG","90","Select","Select",""],["","59746011506","PROCHLORPER","10MG","30","Select","Select",""],["","65162019050","NAPROXEN","500MG","30","Select","Select",""],["","13668001005","CITALOPRAM","20MG","30","Select","Select",""],["","55111029298","SUMATRIPTAN","50MG","8","Select","Select",""],["","50742019001","CYPROHEPTAD","4MG","30","Select","Select",""],["","57237007530","ONDANSETRON","4MG","8","Select","Select",""],["","00527530270","BPM-PSE-DM","2-30-10","200","Select","Select",""],["","42806066305","BUSPIRONE","10MG","40","Select","Select",""],["","43598081115","CETIRIZINE","10MG","30","Select","Select",""],["","00527530270","BPM-PSE-DM ","SYP 2-30-10","200","Select","Select",""],["","67877061115","TIZANIDINE ","CAP 4MG","15","Select","Select",""],["","55111029298","SUMATRIPTAN ","TAB 50MG","8","Select","Select",""],["","50742019001","CYPROHEPTAD ","TAB 4MG","30","Select","Select",""],["","57237007530","ONDANSETRON ","TAB 4MG","8","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":""}]}]}