{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANDRE NURSE","gend":0,"add":"911 NOTTOWAY AVE","city":"BLACKSTONE","state":"VA","zip":"23824-9998","dob":"1965-08-18","age":"","mstatus":"","insh":"20032832*01","cliId":"","pno":8049653678,"cno":8049653678,"email":"","ename":"","eno":"","pphy":"SWAN, DENNIS D MD","ppno":4342927261,"pcpadd":"213 NORTH MAIN ST,","pcpcity":"BLACKSTONE","pcpstate":"VA","pcpzip":"23824-9998","pcpcounty":"","pcpid":"","pcpname":"Blackstone Family Practice Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342927965,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F20.0","F43.10","F33.3","I10.","E78.5","R73.01","F33.40","Z68.26","I16.0","Z20.2","Z09.","B00.1","Z79.899"],"date":["2021-05-02","2021-05-02","2021-05-02","2022-09-08","2022-09-08","2022-09-08","2022-09-08","2022-09-08","2021-07-07","2022-01-05","2022-01-05","2022-02-25","2022-02-25"],"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":[["","63304061650","DOXYCYC MONO CAP","100MG","14","Select","Select",""],["","68645051054","HYDROCHLOROT TAB","25MG","30","Select","Select",""],["","49035056314","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","68645051654","AMLODIPINE TAB","10MG","30","Select","Select",""],["","59746033990","LOSARTAN\/HCT TAB","100-25","30","Select","Select",""],["","68382056410","METOPROL SUC TAB","25MG ER","30","Select","Select",""],["","62332002331","FLUOXETINE CAP","20MG","30","Select","Select",""],["","65162083614","ACYCLOVIR CRE","5%","5","Select","Select",""],["","80777027310","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","49035056317","ASPIRIN EC","81 MG","30","Select","Select",""],["","68645051054","HYDROCHLOROTHIAZIDE","25 MG","30","Select","Select",""],["","68382056410","METOPROLOL SUCCINATE","25 MG","30","Select","Select",""],["","68645051654","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","62332002331","FLUOXETINE HCL","20 MG","30","Select","Select",""],["","59746033990","LOSARTAN-HYDROCHLOROTHIAZIDE","100MG-25MG","30","Select","Select",""],["","63304061650","DOXYCYC MONO","CAP 100MG","14","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","49035056314","ASPIRIN LOW","TAB 81MG EC","90","Select","Select",""],["","62332002331","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","50742061510","METOPROL SUC","TAB 25MG ER","30","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","59746033990","LOSARTAN\/HCT","TAB 100-25","30","Select","Select",""],["","65162083614","ACYCLOVIR","CRE 0.05","5","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":""}]}]}