{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTOPHER   L BELCHER","gend":0,"add":"143 NEW RIDGECREST LN","city":"CLINTWOOD","state":"VA","zip":"24228-9998","dob":"1972-11-18","age":"","mstatus":"","insh":"20042939*01","cliId":"","pno":"276\/870-0154","cno":"","email":"","ename":"","eno":"","pphy":"IBRAHIM, RIMON MD","ppno":"276\/926-4601","pcpadd":"5607 DICKENSON HWY","pcpcity":"CLINTWOOD","pcpstate":"VA","pcpzip":24228,"pcpcounty":"","pcpid":"","pcpname":"DICKENSON MEDICAL CLINIC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/926-4602","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M79.641","R93.7","M54.9","M54.5","Z00.00","R10.9","K21.9","R11.0","H04.123","M54.2","I10.","E78.5","R73.03","F17.200","M25.531","B36.0","G89.29","D22.0","D22.5","L81.4","L91.8","L57.3","L02.223","L84.","Z12.83","J44.9","R10.12","R73.9","R31.21","N20.0","M54.10","R10.30","K62.5","J06.9","J40.","Z12.11","K63.5","Z87.442","F17.210"],"date":["2021-01-21","2021-01-21","2020-04-14","2021-08-23","2021-07-22","2021-08-23","2021-08-23","2021-07-26","2021-09-03","2021-08-23","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-02-08","2021-02-08","2021-09-30","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2020-03-16","2021-07-09","2019-03-25","2019-03-25","2019-05-21","2019-03-15","2019-05-30","2019-06-25","2019-10-25","2019-10-25","2019-06-25","2019-06-25","2019-07-19","2019-06-14"],"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":[["","59676058015","JANSSEN","INJ COVID-19","0","Select","Select",""],["","00406012410","HYDROCO\/APAP","TAB 7.5-325","4","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","10","Select","Select",""],["","43547035310","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","33342020010","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","61442012110","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","18","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","49281040020","ADACEL","INJ ","0","Select","Select",""],["","67877051190","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00536137223","NICOTINE","GUM 4MG MINT","110","Select","Select",""],["","31722071310","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","51672402606","KETOCONAZOLE","TAB 200MG","7","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","500","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","500","Select","Select",""],["","24385035926","GNP","LIQ DM","300","Select","Select",""],["","57237009960","CEFDINIR","CAP 300MG","20","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","2","Select","Select",""],["","68462024801","RANITIDINE","TAB 150MG","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","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":""}]}]}