{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RUSSELL FRIDLEY","gend":0,"add":"383 E CRAIG ST","city":"CRAIGSVILLE","state":"VA","zip":"24430-9998","dob":"1976-12-13","age":"","mstatus":"","insh":"20068507*01","cliId":"","pno":"540\/461-1589","cno":"540\/461-1589","email":"","ename":"","eno":"","pphy":"REED, JOHN P MD","ppno":"540\/932-5687","pcpadd":"53 S MEDICAL PARK DR","pcpcity":"FISHERSVILLE","pcpstate":"VA","pcpzip":22939,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"WESTERN\/ CHARLOTTESVILLE","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/932-5688","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.41","R94.7","R35.0","S81.812A","Z23.","F33.42","H25.23","H25.22","H25.811","Z11.59","M54.5","R10.13","Z86.010","F39.","K31.84","K76.0","R94.5","R79.89","N42.9","F33.0","R10.9","K64.1","S39.012A","X50.0XXA","J32.9","H57.12","R40.0","S99.922A","W22.8XXA"],"date":["2022-03-21","2021-07-01","2020-12-18","2020-12-18","2020-12-18","2021-08-19","2022-02-01","2022-03-09","2022-03-29","2020-08-30","2021-05-07","2020-12-08","2020-09-03","2021-03-05","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2022-01-19","2020-09-03","2020-09-03","2021-05-19","2021-05-19","2022-02-19","2021-08-10","2020-10-23","2021-07-06","2021-07-06"],"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":[]},{"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":[["","00093005301","BUSPIRONE","TAB 5MG","30","Select","Select",""],["","42494040901","CHLORD\/CLIDI","CAP 5-2.5MG","180","Select","Select",""],["","65862069730","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","13668021730","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","31722071101","SILDENAFIL","TAB 100MG","6","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","68645052254","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00254101196","SUCRALFATE","SUS 1GM\/10ML","1200","Select","Select",""],["","65862060230","MODAFINIL","TAB 200MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","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":""}]}]}