{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PAMILA   G STACY","gend":1,"add":"PO BOX 412","city":"BIG ROCK","state":"VA","zip":"24603-9998","dob":"1954-07-18","age":"","mstatus":"","insh":"20035501*01","cliId":"","pno":"276\/312-1862","cno":"","email":"","ename":"","eno":"","pphy":"OWENS, DIA P MD","ppno":"276\/597-7081","pcpadd":"1721 LOVERS GAP ROAD","pcpcity":"VANSANT","pcpstate":"VA","pcpzip":24656,"pcpcounty":"","pcpid":"","pcpname":"ST CHARLES HEALTH COUNCIL INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/546-9709","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H10.45","Z96.1","H52.223","H52.4","H43.313","H43.813","Z23.","Z71.89","Z13.89","I10.","M54.5","M15.0","Z12.31","Z00.8","Z13.9","E03.9","E78.2","Z79.891","Z12.11","H90.5","H25.813","H25.812","R51.","H25.811","F33.0","H11.31"],"date":["2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-07-07","2020-11-23","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2020-11-23","2020-11-23","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-08-24","2020-06-04","2019-10-31","2019-01-15","2019-04-04","2019-08-16","2019-03-08","2019-06-17","2019-10-03"],"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":[["","68180051303","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","00093078701","ATENOLOL","TAB 25MG","30","Select","Select",""],["","00406012405","HYDROCO\/APAP","TAB 7.5-325","60","Select","Select",""],["","69238183007","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","16729021616","SERTRALINE","TAB 50MG","45","Select","Select",""],["","00093720198","PRAVASTATIN","TAB 20MG","30","Select","Select",""],["","","FLUZONE","INJ PF 20-21","","Select","Select",""],["","60505058204","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","68382018101","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00065924007","DUREZOL","EMU 0.0005","5","Select","Select",""],["","47335022090","KETOROLAC","SOL 0.005","5","Select","Select",""],["","00023341660","REFRESH","DRO 0.5-0.9%","60","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":""}]}]}