{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANNIE   R DALTON","gend":1,"add":"2663 WORRELL MEMORIAL ROAD","city":"LAUREL FORK","state":"VA","zip":"24352-9998","dob":"1961-04-08","age":"","mstatus":"","insh":"20026111*01","cliId":"","pno":"276\/266-7007","cno":"276\/266-7007","email":"","ename":"","eno":"","pphy":"BESS, WILLIAM R MD","ppno":"276\/398-2292","pcpadd":"14558 DANVILLE PIKE","pcpcity":"LAUREL FORK","pcpstate":"VA","pcpzip":24352,"pcpcounty":"","pcpid":"","pcpname":"TRI-AREA COMMUNITY HEALTH","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/398-3331","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R00.2","K21.9","G47.00","J45.909","Z23.","L65.9","E55.9","F32.9","E78.2","L20.9","I51.7","I51.89","Z01.419","R06.00","I47.1","Z13.39","Z09.","Z86.010","Z80.0"],"date":["2022-06-15","2022-06-15","2022-06-15","2020-06-09","2022-06-15","2020-08-19","2020-08-19","2021-12-15","2022-06-15","2019-12-09","2019-03-25","2019-03-25","2019-11-07","2019-03-25","2019-03-28","2022-06-15","2022-01-11","2022-01-11","2022-01-11"],"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":[["","55111046601","METOPROL","TAB 25MG ER","30","Select","Select",""],["","68382009810","PAROXETINE","TAB 20MG","30","Select","Select",""],["","55111072510","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","50111043303","TRAZODONE","TAB 50MG","30","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00713022515","TRIAMCINOLON","CRE 0.001","60","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","11","Select","Select",""],["","","SHINGRIX","INJ 50\/0.5ML","","Select","Select",""],["","00378034501","DIAZEPAM","TAB 5MG","1","Select","Select",""],["","00173071620","ADVAIR","AER 115\/21","12","Select","Select",""],["","","ACID","TAB 20MG","","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","49884001908","OMEGA-3-ACID","CAP 1GM","120","Select","Select",""],["","00173088408","LOVAZA","CAP 1GM","120","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","52937000120","VASCEPA","CAP 1GM","120","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":""}]}]}