{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS   E DENNIS JR","gend":0,"add":"432 N BRIDGE ST","city":"EDEN","state":"NC","zip":"27288-9998","dob":"1967-04-14","age":"","mstatus":"","insh":"2316452*01","cliId":"","pno":"402\/690-4257","cno":"402\/690-4257","email":"","ename":"","eno":"","pphy":"SANDERSON, EMILY NP","ppno":"540\/443-3940","pcpadd":"817 A DAVIS ST","pcpcity":"BLACKSBURG","pcpstate":"VA","pcpzip":24060,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/443-3944","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M70.22","R07.2","E11.65","I10.","A41.9","R65.20","M86.172","I50.9","K21.9","E11.9","H52.13","H52.223","E11.40","I96.","S92.412A","E11.621","X58.XXXA","N17.9","Z20.822","E87.1","E87.2","I50.32","M86.9","B19.20","E11.610","E11.69","E78.5","E86.0","E87.6","F12.90","F17.200","M79.675","M86.672","M86.68","M06.9","L97.519","L97.529","D72.829","R26.2","M19.90","Z96.651","Z82.49","Z82.61","Z83.3"],"date":["2021-01-08","2021-02-01","2021-06-04","2021-06-16","2021-06-05","2021-06-05","2021-06-21","2021-06-05","2021-06-16","2021-01-25","2021-01-25","2021-01-25","2021-06-16","2021-06-06","2020-08-14","2021-06-16","2020-08-14","2021-06-04","2021-06-16","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2021-06-16","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2021-06-04","2020-08-27","2020-08-25","2020-08-27","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2021-06-16"],"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":[["","53885019401","ONETOUCH","KIT VERIO FL","1","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","73070010011","INSULIN","INJ 100\/ML","10","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","180","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","50742061610","METOPROL","TAB 50MG ER","30","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","20","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","90","Select","Select",""],["","00310620530","FARXIGA","TAB 5MG","90","Select","Select",""],["","16714047601","AMOX\/K","TAB 250-125","30","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","00904404073","ASPIRIN","CHW 81MG","30","Select","Select",""],["","29300014001","DIVALPROEX","TAB 500MG DR","60","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","360","Select","Select",""],["","75834010901","CHLORTHALID","TAB 25MG","90","Select","Select",""],["","65862041901","SMZ-TMP","TAB 400-80MG","20","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","50111039801","HYDRALAZINE","TAB 10MG","60","Select","Select",""],["","65862042001","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","400","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":""}]}]}