{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RALPH   H WALKER","gend":0,"add":"22272 STANFORD ALLEN LN","city":"ONLEY","state":"VA","zip":"23418-9998","dob":"1961-08-17","age":"","mstatus":"","insh":"20036814*01","cliId":"","pno":"757\/709-3700","cno":"757\/387-2472","email":"","ename":"","eno":"","pphy":"HOLLANDSWORTH, THOMAS MD","ppno":"757\/787-7374","pcpadd":"20306 BADGER LN","pcpcity":"ONLEY","pcpstate":"VA","pcpzip":23418,"pcpcounty":"","pcpid":"","pcpname":"EASTERN SHORE RURAL HEALTH SYSTEM INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/787-4513","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I42.6","I50.22","I10.","Z23.","Z92.29","R19.5","K21.9","G40.909","E78.5","I50.20","NO DATA","I11.0","D72.829","E55.9","I20.9","Z76.89","F17.200","I51.7","R94.31","R97.20","N40.1","Z12.11","K21.0","I42.9","I08.0","F17.210","F10.10","R07.9","R35.1","Z28.21","Z71.3","Z87.891","Z87.19","I42.0","K85.90","K86.1","E04.1","H25.13"],"date":["2021-02-12","2021-02-12","2022-06-27","2022-06-27","2021-04-20","2021-12-16","2021-09-30","2021-06-24","2022-06-27","2022-06-27","2022-06-27","2021-12-27","2020-02-07","2022-06-27","2022-06-27","2020-02-07","2022-06-27","2020-10-06","2020-10-06","2022-11-01","2022-06-27","2021-06-24","2020-08-10","2020-10-05","2021-02-12","2021-12-27","2019-09-09","2019-09-09","2019-11-06","2019-11-06","2019-11-06","2019-07-19","2019-07-19","2019-04-04","2019-09-09","2019-09-09","2022-08-02","2022-06-01"],"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":[["","33342006310","VALSARTAN","TAB 80MG","60","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","60","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","72205000390","ROSUVASTATIN","TAB 10MG","30","Select","Select",""],["","00603020922","MAG","TAB 400MG","30","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","68382009505","CARVEDILOL","TAB 25MG","60","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","1","Select","Select",""],["","66993040932","CARBAMAZEPIN","CAP 300MG ER","60","Select","Select",""],["","","NITROGLYCERN","SUB 0.4MG","","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","","FLUCLVX","INJ 2020-21","","Select","Select",""],["","68180046903","LOVASTATIN","TAB 40MG","30","Select","Select",""],["","23155010410","METFORMIN","TAB 1000MG","30","Select","Select",""],["","65862020399","LOSARTAN","TAB 100MG","15","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":""}]}]}