{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CALVIN KING","gend":0,"add":"141 WHITE ST APT 1","city":"DANVILLE","state":"VA","zip":"24540-9998","dob":"1984-12-27","age":"","mstatus":"","insh":"1371605*01","cliId":"","pno":"434\/709-3328","cno":"434\/709-3328","email":"","ename":"","eno":"","pphy":"SHIFFLETT, JEREMY PA","ppno":"434\/791-4793","pcpadd":"705 MAIN STREET","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/791-4048","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.13","I10.","B20.","Z21.","L02.821","T88.7XXA","L50.1","R11.2","Z91.018","Z53.20","R07.89","R10.84","R11.0","A05.9","K62.89","Z23.","L30.9","L81.4","R11.10","R19.7","R07.9","Z20.828"],"date":["2021-03-23","2021-03-23","2021-10-05","2021-07-13","2020-01-15","2020-01-15","2020-01-30","2020-09-21","2020-09-21","2020-09-21","2020-12-25","2020-09-22","2020-09-22","2020-09-22","2020-11-04","2021-06-22","2020-01-14","2020-01-14","2020-09-21","2020-09-21","2021-03-23","2020-06-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","59267102504","PFIZER","INJ ADLT RTU","0","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","69097012705","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","61958250101","BIKTARVY","TAB ","30","Select","Select",""],["","43199001301","HYOSCYAMINE","TAB 0.125MG","40","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","28","Select","Select",""],["","00093220310","METOCLOPRAM","TAB 10MG","28","Select","Select",""],["","65862017601","PENICILLN","TAB 500MG","28","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","00713022580","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","11","Select","Select",""],["","00093026430","FLUOCINONIDE","OIN 0.0005","30","Select","Select",""],["","23155050110","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","00536109203","ALLERGY","TAB 10MG","30","Select","Select",""],["","00168008031","HYDROCORT","CRE 0.025","30","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}