{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FRANKIE ROSA","gend":0,"add":"2315 LAYNE ST APT B","city":"FARMVILLE","state":"VA","zip":"23901-9998","dob":"1967-12-20","age":"","mstatus":"","insh":"20034297*01","cliId":"","pno":8046312187,"cno":8046312187,"email":"","ename":"","eno":"","pphy":"PRUITT, DAVID E MD","ppno":4343155340,"pcpadd":"935 SOUTH MAIN STREET","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":"23901-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":4343906498,"add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4343152059,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","Z23.","N40.1","N20.0","N43.3","K08.89","E11.9","E11.69","E78.5","R80.1","E11.29","K21.9","F20.9","F20.89","F43.12","E66.3","Z68.27","Z78.9","E55.9","N53.14","Z87.438"],"date":["2023-03-30","2021-03-03","2022-06-14","2021-12-06","2021-12-06","2022-01-13","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2022-06-14","2021-12-06","2021-12-06","2022-06-14","2022-12-13","2022-12-13"],"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":[["","43547034306","RISPERIDONE","3 MG","30","Select","Select",""],["","70954002010","PRAZOSIN HCL","2 MG","90","Select","Select",""],["","69315013801","BENZTROPINE","TAB 2MG","30","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","67877056110","METFORMIN","TAB 500MG","30","Select","Select",""],["","33342006707","OLANZAPINE","2.5 MG","30","Select","Select",""],["","57237001401","TAMSULOSIN","CAP 0.4MG","90","Select","Select",""],["","19515081852","FLULAVAL QUA","INJ 2021-22","0","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","25","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","80777028205","MODERNA BIVA","INJ BA4\/BA5","0","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","69315013801","BENZTROPINE MESYLATE","2 MG","90","Select","Select",""],["","57237001401","TAMSULOSIN HCL","0.4 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":""}]}]}