{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TONY GILBERT","gend":0,"add":"813 LEVEL RUN ROAD","city":"HURT","state":"VA","zip":"24563-9998","dob":"1984-12-17","age":"","mstatus":"","insh":"8278636*01","cliId":"","pno":"434\/324-4315","cno":"434\/324-4315","email":"","ename":"","eno":"","pphy":"BEATTY, GARRETT DO","ppno":"434\/799-4488","pcpadd":"SUITE 201 109 BRIDGE STREET","pcpcity":"DANVILLE","pcpstate":"VA","pcpzip":24541,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/773-6977","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F22.","F23.","V62.84","R44.0","F32.9","F17.210","F33.3","F12.10","Z72.0","R10.9","F32.3","F25.1","F99.","Z74.3","K02.9","R68.84","I10.","R51.9","R09.02","H92.09","R06.89","R00.1","R03.0","F33.2","F14.10","R55.","R10.10","K59.00","R07.9","F32.2","Z59.0","Z79.899","J34.89","R63.0","V62.85","R53.1","R42.","R53.81","F41.9","F19.10","Z20.828","J32.9","H92.03","R09.81","R09.82","Z79.1","R52.","R41.9","H66.93","F29.","F14.20","F12.20","Z91.14","H93.8X1","H93.8X2","F60.0","K42.9","R10.33","R19.7","E66.9","R44.9","F10.10","F17.200","R11.0"],"date":["2022-05-26","2020-08-16","2021-08-11","2020-08-16","2022-05-26","2021-09-04","2021-06-24","2022-05-26","2020-09-21","2021-08-09","2020-10-04","2021-06-29","2020-10-19","2020-11-01","2021-02-20","2021-02-20","2022-05-26","2021-09-04","2021-08-06","2021-09-04","2021-09-04","2021-09-04","2021-09-04","2022-06-07","2022-06-07","2020-09-12","2020-09-12","2020-09-12","2020-09-12","2020-09-12","2021-09-03","2021-09-04","2020-09-21","2020-10-19","2022-05-31","2020-02-13","2022-05-23","2020-07-25","2020-09-13","2020-09-13","2020-09-13","2021-09-04","2021-09-04","2021-09-04","2021-09-04","2021-09-04","2021-09-04","2021-08-11","2021-08-28","2022-05-31","2022-05-31","2022-05-31","2022-05-31","2021-09-03","2021-09-03","2020-08-16","2021-08-08","2021-08-06","2021-08-06","2022-05-26","2022-05-26","2022-05-26","2022-05-26","2020-07-31"],"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":[["","43547034206","RISPERIDONE","TAB 2MG","15","Select","Select",""],["","00904671980","ACETAMINOPHE","TAB 325MG","20","Select","Select",""],["","43547030403","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","00904198280","MAPAP","TAB 325MG","20","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","40","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","10","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","10370010250","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","50458055101","INVEGA","TAB 6MG","90","Select","Select",""],["","10147095303","PALIPERIDONE","TAB ER 6MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","50111043401","TRAZODONE","TAB 100MG","30","Select","Select",""],["","68682010301","DICLOFENAC","TAB 100MG ER","30","Select","Select",""],["","59779030603","CVS","POW ","510","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":""}]}]}