{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAROLD TAYLOR","gend":0,"add":"5300 HAWTHORNE RD APT 401","city":"ROANOKE","state":"VA","zip":"24012-9998","dob":"1958-12-02","age":"","mstatus":"","insh":"20070013*01","cliId":"","pno":"540\/206-0055","cno":"","email":"","ename":"","eno":"","pphy":"WIDNER, AFSANAH S PA","ppno":"540\/362-0360","pcpadd":"3716 MELROSE AVE NW","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":24017,"pcpcounty":"","pcpid":"","pcpname":"KUUMBA COMMUNITY HEALTH AND WELLNESS CENTER INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/566-4102","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.1","E11.9","L08.9","J30.9","E66.9","Z71.3","Z71.89","Z23.","F60.2","F81.0","F45.9","Z65.3","Z91.49","Z56.9","Z65.8","Z12.11","D12.2","K64.8","I10.","F20.9","Z86.010","Z79.82","Z79.84","H40.003","Z11.4","L03.019","K63.5","J45.909","N28.9","H04.123","Z87.438","K62.89","Z01.818"],"date":["2022-11-14","2022-05-18","2021-07-12","2021-07-12","2022-02-07","2022-02-07","2022-02-07","2021-07-12","2022-10-20","2022-10-20","2022-10-20","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-05-18","2022-05-18","2022-05-18","2022-05-18","2022-05-18","2022-05-18","2022-05-18","2022-05-18","2021-08-10","2022-02-07","2021-06-03","2022-05-18","2022-05-18","2020-11-25","2020-11-25","2020-11-25","2021-11-15","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":[]},{"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":[["","65162089703","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","43547029010","BUPROPION","TAB 200MG SR","30","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","60","Select","Select",""],["","00597015390","JARDIANCE","TAB 25MG","30","Select","Select",""],["","00006057762","JANUMET","TAB 50-1000","60","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","60505014102","GLIPIZIDE","TAB 5MG","30","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","62175089143","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","68001050569","POLYETH","POW 3350 NF","510","Select","Select",""],["","69618004610","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","67877022201","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","51672421901","DOXEPIN","CAP 50MG","30","Select","Select",""],["","56151210101","PEN  NEEDLES","MIS 31GX5MM","100","Select","Select",""],["","08222720031","GNP","MIS 32GX5\/32","100","Select","Select",""],["","00193731150","CONTOUR","TES NEXT","200","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","64980030550","DENTA","CRE PLUS","51","Select","Select",""],["","60258015001","SF","CRE 0.011","51","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":""}]}]}