{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACOB CUNDIFF","gend":0,"add":"5704 MALVERN ROAD","city":"ROANOKE","state":"VA","zip":"24012-9998","dob":"1982-03-21","age":"","mstatus":"","insh":"20026049*01","cliId":"","pno":5407288255,"cno":5407288255,"email":"","ename":"","eno":"","pphy":"WIDNER, AFSANAH S PA","ppno":5403620360,"pcpadd":"3716 MELROSE AVE NW,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":"24017-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5405664102,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","Z03.818","R56.9","R40.1","G40.309","G25.3","G40.909","F14.90","F13.20","M54.9","V58.89","G40.409","M77.9","M25.78","NO DATA","M79.631","M79.632","M25.571","Y90.9","G40.901","M19.112","Z87.39","M25.512","G89.29","M75.32","S93.401A","M54.2","S93.324A","Z72.0","Z20.822","K21.9","F17.210","Z79.899","R51.9","R00.0","M19.111","I10.","Z79.82","Z91.199","F14.10","Z91.14","F10.120","R80.9","F19.10","M25.462","S80.212A","W18.30XA","F13.10","N17.9","M25.562","R06.9","S09.90XA","S00.01XA","S50.312A","Z48.89","Z98.1","T84.116A","W19.XXXA"],"date":["2021-03-19","2021-03-19","2023-03-28","2021-09-04","2023-03-26","2023-05-12","2023-05-12","2023-05-12","2022-11-25","2021-11-24","2022-09-16","2022-11-22","2022-11-22","2022-11-22","2023-03-28","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2023-03-26","2022-09-21","2022-09-21","2022-07-19","2022-07-19","2022-07-27","2022-08-06","2022-08-06","2023-06-28","2022-08-24","2023-05-12","2022-09-02","2023-03-26","2022-09-02","2021-09-05","2021-09-05","2022-09-02","2022-09-02","2022-09-02","2023-03-27","2023-03-28","2023-03-26","2023-02-26","2023-02-21","2023-03-28","2023-03-28","2023-03-28","2023-03-28","2023-03-26","2023-03-26","2023-03-26","2023-03-26","2023-03-26","2023-03-26","2023-03-26","2023-06-28","2023-06-28","2023-06-28","2023-06-28"],"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":[["","29300043001","ZONISAMIDE","100 MG","120","Select","Select",""],["","65862023060","LAMOTRIGINE","200 MG","120","Select","Select",""],["","00093321205","CLONAZEPAM","1 MG","60","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00093216568","NALOXONE HCL","SPR 4MG","2","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","28","Select","Select",""],["","57896092110","ASPIRIN","TAB 325MG EC","30","Select","Select",""],["","00406012505","HYDROCO\/APAP","TAB 10-325MG","30","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","53746014501","HYDROCOD\/IBU","TAB 7.5-200","30","Select","Select",""],["","62332004060","LAMOTRIGINE TAB","200MG","120","Select","Select",""],["","29300043001","ZONISAMIDE CAP","100MG","120","Select","Select",""],["","00093321205","CLONAZEPAM TAB","1MG","60","Select","Select",""],["","16571020150","DICLOFENAC TAB","75MG DR","30","Select","Select",""],["","00406055201","OXYCODONE TAB","5MG","28","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","00406012505","HYDROCO\/APAP TAB","10-325MG","30","Select","Select",""],["","53746014501","HYDROCOD\/IBU TAB","7.5-200","30","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","57896092110","ASPIRIN TAB","325MG EC","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":""}]}]}