{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHANDRA HODGE","gend":1,"add":"51 ATLANTIC CIR","city":"MARTINSVILLE","state":"VA","zip":"24112-9998","dob":"1979-05-13","age":"","mstatus":"","insh":"20055902*01","cliId":"","pno":2768064111,"cno":2768064111,"email":"","ename":"","eno":"","pphy":"SAAD, MOHAMMED MD","ppno":2766667827,"pcpadd":"320 HOSPITAL DR,","pcpcity":"MARTINSVILLE","pcpstate":"VA","pcpzip":"24112-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2766667566,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E22.1","D35.2","N92.6","E55.9","F31.81","F90.2","R93.89","F33.1","D47.2","NO DATA","Z00.00","F90.0","F33.2","F41.9","M79.7","E04.1","M25.461","M25.462","M25.561","M25.562","N89.8","I63.30"],"date":["2022-07-27","2022-07-27","2022-07-27","2022-07-27","2023-06-01","2023-06-01","2022-05-18","2022-06-30","2022-12-29","2023-03-23","2021-05-19","2021-05-19","2021-07-27","2021-05-19","2021-05-19","2021-05-19","2022-12-06","2022-12-06","2022-12-06","2022-12-06","2022-02-22","2022-06-02"],"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":[["","00597002402","COMBIVENT AER","20-100","4","Select","Select",""],["","00006033530","BELSOMRA TAB","20MG","30","Select","Select",""],["","00536100901","FERROUS SULF TAB","325MG","180","Select","Select",""],["","00456114030","VIIBRYD TAB","40MG","30","Select","Select",""],["","00228306111","AMPHET\/DEXTR CAP","30MG ER","60","Select","Select",""],["","55111052230","ATOMOXETINE CAP","60MG","30","Select","Select",""],["","49884028901","MEGESTROL AC TAB","20MG","30","Select","Select",""],["","00904759060","FEROSUL TAB","325MG","180","Select","Select",""],["","69097084507","CYCLOBENZAPR TAB","5MG","90","Select","Select",""],["","43598029390","PREGABALIN CAP","75MG","60","Select","Select",""],["","24478010901","DYANAVEL XR CHW","15MG","30","Select","Select",""],["","70436001002","BUPROPN HCL TAB","150MG XL","90","Select","Select",""],["","00781107905","ALPRAZOLAM TAB","1MG","180","Select","Select",""],["","60505477403","VILAZODONE TAB","40MG","30","Select","Select",""],["","31722053101","TORSEMIDE TAB","20MG","7","Select","Select",""],["","00781107905","ALPRAZOLAM","1 MG","180","Select","Select",""],["","24478010601","DYANAVEL XR","5 MG","30","Select","Select",""],["","16729035410","VILAZODONE HCL","40 MG","30","Select","Select",""],["","68180031909","BUPROPION XL","150 MG","90","Select","Select",""],["","59417010710","VYVANSE","70 MG","30","Select","Select",""],["","69097068505","PREGABALIN","300 MG","60","Select","Select",""],["","55111052230","ATOMOXETINE HCL","60 MG","30","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","65162047810","NITROFURANTOIN MONO-MACRO","100 MG","10","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":""}]}]}