{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RONALD SUTPHIN","gend":0,"add":"48 LANGHORN LN APT 7","city":"MEADOWS OF DAN","state":"VA","zip":"24120-9998","dob":"1964-01-10","age":"","mstatus":"","insh":"20048397*01","cliId":"","pno":"540\/915-7650","cno":"","email":"","ename":"","eno":"","pphy":"HODGES JR, WALTER CURTIS NP","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":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/398-3331","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F19.10","V62.84","N48.21","N52.9","R06.02","F17.200","F19.94","Z20.828","F43.10","Z86.19","M19.90","R46.2","F41.9","F32.9","S61.412A","F10.20","F15.20","F14.10","F33.1","F10.10","M54.2","J20.8","R94.31","F41.8","F33.2"],"date":["2020-03-12","2020-05-25","2021-08-19","2021-08-19","2021-08-19","2021-08-19","2020-01-05","2020-08-07","2020-07-23","2020-07-23","2020-07-23","2020-01-01","2020-05-25","2020-05-25","2019-02-06","2019-03-12","2019-02-07","2019-02-07","2019-07-26","2019-03-05","2019-07-14","2019-12-06","2019-12-06","2019-12-27","2019-07-16"],"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":[["","68382078301","DOXAZOSIN","TAB 1MG","30","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","10702001110","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","13668013705","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","13107003105","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","60219175303","SILDENAFIL","TAB 100MG","10","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","","ARIPIPRAZOLE","TAB 5MG","","Select","Select",""],["","","MUCINEX","TAB 60-1200","","Select","Select",""],["","","HYDROCHLOROT","TAB 25MG","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","00378230201","PRAZOSIN","CAP 2MG","30","Select","Select",""],["","","CVS","DIS 21MG\/24H","","Select","Select",""],["","00536589488","NICOTINE","DIS 7MG\/24HR","28","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","50111043303","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","12","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":""}]}]}