{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KENNETH WARD","gend":0,"add":"5602 US HWY 340 BSN","city":"STANLEY","state":"VA","zip":"22851-9998","dob":"1964-07-29","age":"","mstatus":"","insh":"1710671*01","cliId":"","pno":4342494576,"cno":4342494576,"email":"","ename":"","eno":"","pphy":"KOCH, ADRIENNE J DO","ppno":5407134100,"pcpadd":"13737 SPOTSWOOD TRAIL","pcpcity":"ELKTON","pcpstate":"VA","pcpzip":"22827-9998","pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara East Rockingham Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575798587,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.822","B20.","R07.9","J01.90","Z68.25","R03.0","I10.","I25.10","E78.2","NO DATA","Z72.0","Z23.","R21.","I26.94","M21.372","F17.210","E78.00","Z86.711","Z21.","Z88.0","Z88.1","R53.1","S90.852A","Z79.01","M79.672","M76.72","H04.123","T78.1XXA","H04.129","E78.5","Z87.891","Z79.899","Z11.3","Z00.00","D72.820","F43.23"],"date":["2021-08-03","2023-03-22","2022-04-19","2022-04-19","2022-04-19","2022-04-19","2023-03-22","2023-03-22","2021-01-14","2021-01-14","2021-01-14","2022-01-25","2021-07-20","2021-07-20","2022-12-12","2022-12-12","2022-12-12","2022-12-12","2022-12-12","2022-12-12","2022-12-12","2022-12-12","2021-11-08","2022-05-02","2021-12-03","2021-12-03","2022-05-31","2021-06-14","2022-05-02","2022-05-02","2022-05-02","2023-03-22","2023-03-22","2023-03-22","2023-03-22","2021-10-26"],"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":[["","60505257809","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","59676057530","PREZCOBIX","800-150 MG","30","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","00003089321","ELIQUIS","TAB 2.5MG","60","Select","Select",""],["","00069047103","CHANTIX","PAK 0.5& 1MG","53","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","00955101010","ENOXAPARIN","INJ 100MG\/ML","6","Select","Select",""],["","58160088752","FLUARIX QUAD","INJ 2021-22","0","Select","Select",""],["","62332025050","DOXYCYC MONO","CAP 100MG","20","Select","Select",""],["","24208079535","NEO\/POLY\/DEX","OIN 0.1% OP","4","Select","Select",""],["","64380071306","BENZONATATE","CAP 200MG","30","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","69097012705","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","60505257809","ATORVASTATIN CALCIUM","10 MG","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":""}]}]}