{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIMOTHY   D WALLS","gend":0,"add":"12630 OLD RIDGE ROAD","city":"BEAVERDAM","state":"VA","zip":"23015-9998","dob":"1968-06-28","age":"","mstatus":"","insh":"20060759*01","cliId":"","pno":"804\/396-1735","cno":"","email":"","ename":"","eno":"","pphy":"YOUNG, CHRISTINE M MD","ppno":"804\/798-9208","pcpadd":"306 ASHCAKE RD STE C","pcpcity":"ASHLAND","pcpstate":"VA","pcpzip":23005,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS INTERNAL MEDICINE OF ASHLAND","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/798-8108","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","M79.671","E11.9","M79.672","F32.9","M62.838","Z68.26","F41.8","G62.9","J44.9","Z68.25","Z20.822","R73.01","R10.13","Z68.31","NO DATA","K63.5","E78.2","Z13.31","R63.4","K62.5","Z68.24","R10.30","R10.11","R10.2"],"date":["2022-09-20","2020-04-22","2022-09-20","2020-04-22","2021-07-12","2020-10-13","2021-09-27","2021-11-12","2021-07-12","2021-07-12","2021-07-12","2021-12-06","2019-10-18","2019-10-18","2019-10-18","2022-09-20","2022-09-20","2022-09-20","2022-06-21","2022-06-21","2022-06-21","2022-06-21","2022-05-13","2022-05-13","2022-05-13"],"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":[["","57237001930","DULOXETINE","CAP 60MG","30","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","60","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","16729018201","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","68645049254","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","50742061610","METOPROL","TAB 50MG ER","30","Select","Select",""],["","68645048154","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","","BENAZEPRIL","TAB 20MG","","Select","Select",""],["","","TIZANIDINE","CAP 4MG","","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","","DICLOFENAC","GEL 0.03","","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","43598065530","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","TADALAFIL","TAB 5MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","SOLARAZE","GEL 3% W\/W","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","00185021101","BENAZEP\/HCTZ","TAB 20-12.5","30","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}