{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RITA  M ROBERTS","gend":1,"add":"915 MCCULLOCH ST","city":"GLASGOW","state":"VA","zip":"24555-9998","dob":"1960-05-17","age":"","mstatus":"","insh":"20034120*01","cliId":"","pno":5407845597,"cno":5407845597,"email":"","ename":"","eno":"","pphy":"ELZA, BETHANY DO","ppno":5404648700,"pcpadd":"25 NORTHRIDGE LN,","pcpcity":"LEXINGTON","pcpstate":"VA","pcpzip":"24450-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5404641362,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.822","Z12.2","I25.10","R91.8","F17.210","Z23.","R00.2","E78.5","R01.1","R07.9","M54.5","G89.29","R31.9","I10.","E55.9","Z28.21","E78.00","Z72.0","I35.0","C44.712","D22.61","D22.5","L81.4","L81.2","L85.3","L57.8","D48.5"],"date":["2022-08-08","2022-09-15","2022-09-15","2022-09-15","2022-09-15","2021-12-03","2022-04-27","2022-04-27","2022-04-27","2022-04-27","2021-03-03","2021-03-03","2021-03-03","2022-01-26","2021-03-03","2021-03-03","2022-01-26","2022-01-26","2022-03-23","2022-02-02","2022-01-12","2022-01-12","2022-01-12","2022-01-12","2022-01-12","2022-01-12","2022-01-12"],"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":[["","70700015010","OMEPRAZOLE","20 MG","90","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","90","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","10","Select","Select",""],["","68180046403","SIMVASTATIN","40 MG","90","Select","Select",""],["","00904678370","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","29300041319","CYCLOBENZAPRINE HCL","5 MG","30","Select","Select",""],["","49035056317","ASPIRIN EC","81 MG","30","Select","Select",""],["","68645052354","SERTRALINE HCL","100 MG","90","Select","Select",""],["","55111015810","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","69097083512","SERTRALINE TAB","100MG","90","Select","Select",""],["","52817033010","CYCLOBENZAPR TAB","5MG","30","Select","Select",""],["","68180047903","SIMVASTATIN TAB","20MG","90","Select","Select",""],["","68382005105","MELOXICAM TAB","15MG","10","Select","Select",""],["","00904678370","ASPIRIN LOW TAB","81MG 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":""}]}]}