{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANICE GONZALEZ","gend":1,"add":"153 CARSON AVE APT 17","city":"RICHLANDS","state":"VA","zip":"24641-9998","dob":"1985-05-02","age":"","mstatus":"","insh":"1961665*01","cliId":"","pno":"276\/971-8794","cno":"","email":"","ename":"","eno":"","pphy":"TITHA, RAVI K MD","ppno":"276\/964-6711","pcpadd":"3150 CLINCH ST","pcpcity":"RICHLANDS","pcpstate":"VA","pcpzip":"24641","pcpcounty":"","pcpid":"","pcpname":"RAVI K TITHA","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"844\/331-2990","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.01","G44.029","E78.2","J30.1","R13.12","G47.00","M54.5","F33.1","T78.49XA","L93.1","J02.9","NO DATA","J44.9","M15.0","J02.8","T40.2X1A","J01.40","M54.9","J01.80","J01.81","J20.9","J01.11","Z11.52"],"date":["2021-11-30","2021-07-22","2021-11-30","2021-02-11","2020-06-16","2020-06-16","2021-09-27","2021-12-03","2021-06-15","2021-11-30","2021-08-19","2021-11-30","2021-04-22","2021-07-22","2020-09-16","2020-08-14","2021-03-09","2020-02-07","2021-09-27","2020-07-15","2020-11-16","2021-05-17","2021-09-27"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","55111029136","SUMATRIPTAN","TAB 25MG","18","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","60","Select","Select",""],["","00536131385","CHEST","SYP REL DM","105","Select","Select",""],["","59779035934","TUSSIN","LIQ 10-100\/5","105","Select","Select",""],["","00023650110","UBRELVY","TAB 100MG","30","Select","Select",""],["","59779006764","ANTIBIOTIC","OIN ","28","Select","Select",""],["","65862052405","GABAPENTIN","TAB 800MG","90","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00555030202","HYDROXYZ","CAP 50MG","60","Select","Select",""],["","00810073088",""," ","14","Select","Select",""],["","00904530780","BANOPHEN","CAP 50MG","90","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","20","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","59779082356","TRI","OIN PAIN REL","28","Select","Select",""],["","74312001380","VITAMIN","TAB 1000MCG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","67877012440","SILVER","CRE 0.01","400","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","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":""}]}]}