{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LIZA   LEANN DAVIS","gend":1,"add":"6008 GUEST RIVER RD LOT 1","city":"NORTON","state":"VA","zip":"24273-9998","dob":"1978-10-08","age":"","mstatus":"","insh":"20065978*01","cliId":"","pno":"276\/210-0502","cno":"","email":"","ename":"","eno":"","pphy":"STANLEY, NATASHA M NP","ppno":"276\/598-4448","pcpadd":"460 FRONT STREET","pcpcity":"RICHLANDS","pcpstate":"VA","pcpzip":24641,"pcpcounty":"","pcpid":"","pcpname":"HOPKINS MEDICAL ASSOCIATION LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/598-4635","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F15.10","F12.10","F32.9","F17.200","B18.2","F12.20","G25.81","G62.9","M54.9","F33.0","F41.1","F15.20","F17.211","F17.210","Z71.51","Z32.02","F41.8","F31.9","M54.41","N39.0","H92.01","Z03.818","Z79.891","NO DATA","F12.21","F10.21"],"date":["2021-07-02","2021-04-20","2020-06-24","2020-06-15","2021-04-20","2021-03-31","2021-04-20","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2021-06-04","2020-06-29","2020-06-29","2021-07-02","2021-05-13","2021-07-02","2021-05-27","2021-07-02","2020-05-10","2020-05-10","2021-12-18","2021-12-18","2020-06-24","2021-06-04","2020-10-02","2020-10-02"],"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":[["","","PREGABALIN","CAP 75MG","","Select","Select",""],["","","BUPREN\/NALOX","SUB 8-2MG","","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","","BUPROPN","TAB 150MG XL","","Select","Select",""],["","","SERTRALINE","TAB 50MG","","Select","Select",""],["","","CLONAZEPAM","TAB 0.5MG","","Select","Select",""],["","00185041501","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","","TIZANIDINE","TAB 4MG","","Select","Select",""],["","","SUBOXONE","MIS 8-2MG","","Select","Select",""],["","","HYDROXYZ","CAP 25MG","","Select","Select",""],["","","CHLORTHALID","TAB 25MG","","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","","MELOXICAM","TAB 7.5MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","GABAPENTIN","TAB 600MG","","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":""}]}]}