{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARTHA ADKINS","gend":1,"add":"PO BOX 2616","city":"WISE","state":"VA","zip":"24293-9998","dob":"1970-02-14","age":"","mstatus":"","insh":"20043705*01","cliId":"","pno":"276\/328-9660","cno":"","email":"","ename":"","eno":"","pphy":"THOMAS, SIERRA R PA","ppno":"865\/673-5000","pcpadd":"1342 PAPERMILL POINTE WY","pcpcity":"KNOXVILLE","pcpstate":"TN","pcpzip":37909,"pcpcounty":"","pcpid":"","pcpname":"ASSOCIATED PAIN SPECIALISTS PC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"865\/330-6323","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z74.01","M54.9","M51.36","M25.60","R53.1","R26.2","Z74.09","R68.89","M54.5","C34.91","G89.3","F41.9","F32.9","Z20.822","G89.28","Z79.899","I10.","Z91.14","M47.816","R06.02","R07.89","J96.91","R05.","J06.9","G47.01","R00.2","R53.81","L98.9","R07.9","R53.83","Z12.4","Z12.11","G89.29","F11.23","F13.239","R46.81","R19.7","H65.01","R82.5","F11.20","F13.20","H74.8X1","R51.9","M54.16","D64.9","J20.9","I28.1","E78.2","Z12.31","Z00.00","M47.9","L82.1"],"date":["2021-02-10","2021-02-10","2021-11-03","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2021-10-25","2021-02-27","2021-02-25","2021-02-04","2021-02-24","2021-02-24","2021-02-27","2021-11-03","2021-11-03","2021-11-03","2021-06-15","2021-11-03","2020-11-02","2020-08-28","2021-02-10","2021-02-24","2021-02-24","2021-02-24","2020-06-29","2020-06-29","2020-06-29","2020-10-01","2020-06-29","2020-08-31","2020-08-31","2021-02-10","2021-03-06","2021-03-06","2021-03-06","2020-01-27","2021-02-04","2021-01-28","2021-02-04","2021-01-28","2021-02-04","2021-03-06","2019-03-02","2019-05-08","2019-07-02","2019-05-28","2019-05-03","2019-05-03","2019-05-03","2019-02-02","2019-10-02"],"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":[["","50742061710","METOPROL","TAB 100MG ER","30","Select","Select",""],["","68645055254","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","43386035701","HYDROCO\/APAP","TAB 7.5-325","120","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","40","Select","Select",""],["","","AMLODIPINE","TAB 5MG","","Select","Select",""],["","","DULOXETINE","CAP 30MG","","Select","Select",""],["","00406052201","OXYCOD\/APAP","TAB 7.5-325","60","Select","Select",""],["","13107008405","LORAZEPAM","TAB 1MG","60","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","20","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","30","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","30","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","FLUOXETINE","CAP 40MG","","Select","Select",""],["","49035007021","EQ","TAB 600MG","60","Select","Select",""],["","00536589488","NICOTINE","DIS 7MG\/24HR","28","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","63824000869","MUCINEX","TAB 600MG ER","60","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","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":""}]}]}