{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN H MONROE","gend":0,"add":"PO BOX 314","city":"LANCASTER","state":"VA","zip":"22503-9998","dob":"1961-03-21","age":"","mstatus":"","insh":"20032276*01","cliId":"","pno":7573039841,"cno":7573039841,"email":"","ename":"","eno":"","pphy":"BAVUSO, SALVATORE MD","ppno":8044625155,"pcpadd":"36 LIVELY OAKS ROAD,","pcpcity":"LIVELY","pcpstate":"VA","pcpzip":"22507-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours Lively Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8044625922,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I25.10","Z95.1","I10.","I45.2","E78.2","F17.210","Z68.28","N52.01","I11.9","I34.0","F17.200","Z68.26","Z68.27","R73.9","K75.9","Z23.","I08.3","J30.1","I49.9","R00.2","I48.91","I49.3","I48.4","I07.1","I48.0","R00.1","R94.31","Z79.01","Z72.0","E78.00"],"date":["2023-08-30","2023-07-21","2023-08-30","2023-07-21","2023-07-21","2022-06-14","2021-12-14","2022-06-14","2021-10-07","2023-07-21","2023-07-21","2023-01-19","2022-11-18","2023-02-17","2021-01-11","2022-03-15","2022-06-25","2021-05-05","2023-08-16","2023-07-21","2023-08-30","2023-07-27","2023-08-16","2023-08-16","2023-07-21","2023-08-16","2023-08-16","2023-08-30","2023-08-30","2023-08-30"],"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":[["","49483048112","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","65162075410","BENAZEPRIL","TAB 40MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE","40 MG","30","Select","Select",""],["","50742061710","METOPROL SUC","TAB 100MG ER","30","Select","Select",""],["","00173071920","FLOVENT HFA","110 MCG","12","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","70377000911","ROSUVASTATIN","TAB 40MG","90","Select","Select",""],["","69238115409","EZETIMIBE","10 MG","90","Select","Select",""],["","66993007996","FLUTICAS HFA","AER 110MCG","12","Select","Select",""],["","49483048112","ASPIRIN EC","81 MG","30","Select","Select",""],["","50742061710","METOPROLOL SUCCINATE","100 MG","30","Select","Select",""],["","16571040250","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","66993007996","FLUTICASONE PROPIONATE HFA","110 MCG","12","Select","Select",""],["","70377000911","ROSUVASTATIN CALCIUM","40 MG","30","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","65862011801","BENAZEPRIL HCL","40 MG","90","Select","Select",""],["","50742061710","METOPROL SUC TAB","100MG ER","90","Select","Select",""],["","65862011801","BENAZEPRIL TAB","40MG","90","Select","Select",""],["","59651000305","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","16571040250","CETIRIZINE TAB","10MG","90","Select","Select",""],["","00173071920","FLOVENT HFA AER","110MCG","12","Select","Select",""],["","68180072103","AMLODIPINE TAB","10MG","90","Select","Select",""],["","49483048112","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","70377000911","ROSUVASTATIN TAB","40MG","30","Select","Select",""],["","69238115409","EZETIMIBE TAB","10MG","30","Select","Select",""],["","66993007996","FLUTICAS HFA AER","110MCG","12","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","50228014610","HYDROCHLOROTHIAZIDE","12.5 MG","90","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":""}]}]}