{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ARTHUR D JONES","gend":0,"add":"9830 INDIAN ROAD CHARLES CITY","city":"CHARLES CITY","state":"VA","zip":"23030-9998","dob":"1972-03-12","age":"","mstatus":"","insh":"20071907*01","cliId":"","pno":8043061687,"cno":8043061687,"email":"","ename":"","eno":"","pphy":"GOKLI, J ANUP MD","ppno":8049324388,"pcpadd":"1850 POCAHONTAS TR,","pcpcity":"QUINTON","pcpstate":"VA","pcpzip":"23141-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8049329860,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","F60.3","F60.2","F41.1","G89.4","E78.2","G62.9","R73.09","M48.07","Z79.899","F43.12","E55.9","Z12.5","F43.10","M79.604","M79.605","F17.200","R26.9","I47.1","I73.9","F17.210","M47.817","Z98.1","M51.36","M43.16","K04.7","I70.213","R53.83","M25.512","E29.1","NO DATA","S93.402A","I70.219","M62.81","K64.8","K50.112","K64.0","K57.30","F32.2","Z87.891"],"date":["2023-09-27","2022-06-09","2022-06-09","2023-09-14","2022-06-09","2023-09-14","2022-05-23","2023-09-14","2023-09-14","2022-05-23","2023-09-14","2023-09-14","2022-05-23","2023-09-27","2021-04-28","2021-04-28","2021-04-28","2021-04-28","2021-10-05","2021-06-14","2021-10-05","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2021-02-27","2021-04-28","2023-09-14","2023-09-14","2023-09-14","2023-06-28","2021-11-23","2021-03-31","2023-04-04","2023-06-28","2023-06-28","2023-06-28","2023-06-28","2023-09-14","2023-09-14"],"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":[["","57237017401","VENLAFAXINE","TAB 50MG","30","Select","Select",""],["","68382011514","RISPERIDONE","TAB 2MG","30","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","50580053501","BENADRYL ALL","LIQ 12.5\/5ML","118","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","42571016242","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","00378001801","METOPROL TAR","TAB 25MG","180","Select","Select",""],["","63304082990","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","57237001890","DULOXETINE","CAP 30MG","60","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","42","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","7","Select","Select",""],["","71247015201","HALOPERIDOL","TAB 2MG","30","Select","Select",""],["","67877025001","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","61442010201","DICLOFENAC","TAB 50MG DR","60","Select","Select",""],["","16729016917","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","10572010001","PEG-","3350 AND ELECTROLYTES 236-22.74G","4000","Select","Select",""],["","61442010201","DICLOFENAC SODIUM","50 MG","60","Select","Select",""],["","60505258008","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","43547028110","ESCITALOPRAM OXALATE","10 MG","30","Select","Select",""],["","43386009019","GAVILYTE-G","236-22.74G","4000","Select","Select",""],["","63304082990","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","71247015201","HALOPERIDOL TAB","2MG","30","Select","Select",""],["","57237001890","DULOXETINE CAP","30MG","60","Select","Select",""],["","16729016917","ESCITALOPRAM TAB","10MG","30","Select","Select",""],["","61442010201","DICLOFENAC TAB","50MG DR","60","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":""}]}]}