{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACOB   M STROUTH","gend":0,"add":"330 OAKWOOD LN STE 200","city":"SUGAR GROVE","state":"VA","zip":"24375-9998","dob":"1998-11-09","age":"","mstatus":"","insh":"20069113*01","cliId":"","pno":"276\/780-9823","cno":"276\/780-9823","email":"","ename":"","eno":"","pphy":"YOUSUF, SAMINA MD","ppno":"276\/889-0433","pcpadd":"142 HIGHLANDS DR","pcpcity":"LEBANON","pcpstate":"VA","pcpzip":24266,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"423\/431-1457","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R40.4","R05.9","F17.210","Z20.822","R06.02","S60.451A","Z23.","Z72.0","R60.9","Z11.3","N48.29","K02.7","T50.901A","R56.9","NO DATA","K29.00","J02.9","K08.9","L03.90","L02.01","L03.211","T43.011A","K02.9","K08.89"],"date":["2021-11-17","2021-12-23","2022-05-12","2021-12-23","2021-12-23","2022-04-16","2022-04-16","2022-04-16","2022-04-16","2022-05-12","2022-05-12","2022-04-25","2021-11-18","2021-11-18","2021-11-18","2022-03-22","2020-09-18","2020-09-18","2022-01-08","2022-01-08","2022-01-08","2021-11-17","2022-04-25","2022-04-25"],"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":[["","00378306577","FENOFIBRATE","TAB 48MG","90","Select","Select",""],["","65862018501","CLINDAMYCIN","CAP 150MG","84","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","12","Select","Select",""],["","31722077701","ACYCLOVIR","TAB 400MG","60","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","68001043490","NICOTINE","DIS STEP 1","28","Select","Select",""],["","67877024201","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","31722070430","VALACYCLOVIR","TAB 500MG","60","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","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":""}]}]}