{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROY NUCKOLS","gend":0,"add":"PO BOX 82","city":"MIDDLETOWN","state":"VA","zip":"22645-9998","dob":"1975-02-11","age":"","mstatus":"","insh":"20070857*01","cliId":"","pno":"540\/335-3417","cno":"540\/335-3417","email":"","ename":"","eno":"","pphy":"AGYEIWAAH, MAVIS A MD","ppno":"540\/536-5400","pcpadd":"1440 AMHERST ST","pcpcity":"WINCHESTER","pcpstate":"VA","pcpzip":22601,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/536-5490","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D64.9","D68.51","K70.30","D69.6","M10.9","R60.0","K72.90","K74.60","K76.6","R18.8","M79.661","R22.41","Z01.818","M79.674","M72.2","K70.31","R53.83","Z72.0","I85.10","K31.89","D50.0","L08.9","J01.00"],"date":["2021-01-26","2021-01-26","2020-12-29","2020-12-29","2021-01-27","2021-02-10","2020-12-22","2021-01-26","2021-01-07","2020-12-21","2021-02-08","2021-02-08","2020-12-21","2021-01-20","2020-12-03","2020-12-22","2020-12-22","2020-12-22","2021-01-07","2021-01-07","2021-01-07","2021-01-08","2021-01-08"],"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":[["","16714007701","TADALAFIL","TAB 20MG","30","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","60505132101","MIDODRINE","TAB 5MG","90","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","30","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","47781064390","LEVOTHYROXIN","TAB 50MCG","30","Select","Select",""],["","72305005030","EUTHYROX","TAB 50MCG","30","Select","Select",""],["","00121074710","SUCRALFATE","SUS 1GM\/10ML","420","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","59746021801","SPIRONOLACT","TAB 100MG","90","Select","Select",""],["","58914017014","CARAFATE","SUS 1GM\/10ML","420","Select","Select",""],["","70074050463","ENSURE","LIQ CHOCOLAT","237","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":""}]}]}