{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALEXANDER S EVERSOLE","gend":0,"add":"755 DILLON ST","city":"PULASKI","state":"VA","zip":"24301-9998","dob":"2003-11-10","age":"","mstatus":"","insh":"1536922*01","cliId":"","pno":5403209071,"cno":5403209071,"email":"","ename":"","eno":"","pphy":"SAMPLES, RANDALL G MD","ppno":5406749359,"pcpadd":"5562 COUGAR TRAIL RD,","pcpcity":"DUBLIN","pcpstate":"VA","pcpzip":"24084-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5406751825,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.2","S02.0XXA","S06.899A","S06.310A","S06.320A","R45.1","S06.893A","V89.2XXA","G44.311","I62.00","R51.9","S06.4X9S","V58.89","S02.81XA","S02.31XA","S37.20XA","S06.9X0A","R53.83","R63.8","S06.5X0A","S06.360A","S02.85XA","L03.012","R11.10","Z87.891","M79.89","V87.7XXA","R50.81","S06.4X0A","S06.330A","S02.92XA","H57.13","I80.9","I82.611","M79.604","R41.841","I62.9","F80.9","F09.","F31.32","S02.91XA","S02.2XXA","U07.1","Z20.822","S06.5X9A","S00.12XA","S00.11XA","S40.811A","S09.8XXA","R41.82","R11.2","H53.2","E87.1","V89.2XXD","V54.19","S02.85XD","K92.0","S06.6X9A","G89.11","S02.19XA","S06.4X9A","N32.89","S00.81XA","K59.00","I10."],"date":["2022-05-09","2022-02-05","2022-02-05","2022-02-07","2022-02-05","2022-02-07","2022-02-07","2022-02-07","2022-02-12","2022-02-12","2022-02-14","2022-02-14","2022-02-21","2022-02-11","2022-02-07","2022-02-07","2022-02-11","2022-02-11","2022-02-11","2022-02-12","2022-02-11","2022-02-11","2022-02-17","2022-02-17","2022-02-17","2022-02-17","2022-02-04","2022-02-13","2022-02-14","2022-02-04","2022-02-04","2022-02-14","2022-02-14","2022-02-14","2022-02-14","2022-02-21","2022-02-21","2022-02-21","2022-02-21","2022-03-01","2022-02-04","2022-02-04","2021-10-06","2021-10-06","2022-02-04","2022-02-04","2022-02-04","2022-02-04","2022-02-04","2022-02-04","2022-02-12","2022-02-21","2022-02-21","2022-02-21","2022-02-22","2022-02-22","2022-02-04","2022-02-04","2022-02-04","2022-02-04","2022-02-04","2022-02-04","2022-02-04","2022-02-04","2022-02-04"],"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":[["","69367020301","BUT\/APAP\/CAF TAB","","30","Select","Select",""],["","43547040550","METHOCARBAM TAB","500MG","56","Select","Select",""],["","51079030630","POLYETH GLYC POW","3350 NF","30","Select","Select",""],["","00536124710","SENEXON-S TAB","8.6-50MG","28","Select","Select",""],["","31722053712","LEVETIRACETA TAB","500MG","1","Select","Select",""],["","51991001406","MELATONIN TAB","3MG","28","Select","Select",""],["","50111056002","TRAZODONE TAB","50MG","7","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","10","Select","Select",""],["","63304069201","CLINDAMYCIN CAP","150MG","42","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","42","Select","Select",""],["","50111056002","TRAZODONE","TAB 50MG","7","Select","Select",""],["","31722053712","LEVETIRACETA","TAB 500MG","1","Select","Select",""],["","43547040550","METHOCARBAM","TAB 500MG","56","Select","Select",""],["","51079030630","POLYETH GLYC","POW 3350 NF","30","Select","Select",""],["","00536124710","SENEXON-S","TAB 8.6-50MG","28","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","51991001406","MELATONIN","TAB 3MG","28","Select","Select",""],["","69367020301","BUT\/APAP\/CAF","TAB ","30","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":""}]}]}