{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHRISTOPHER SINES","gend":0,"add":"2654 PENICKS MILL ROAD","city":"BEDFORD","state":"VA","zip":"24523-9998","dob":"1988-10-24","age":"","mstatus":"","insh":"20074065*01","cliId":"","pno":5405212048,"cno":5405212048,"email":"","ename":"","eno":"","pphy":"WILD-GINGELESKI, ANDREA FNP","ppno":5404257910,"pcpadd":"582 BLUE RIDGE AVE,","pcpcity":"BEDFORD","pcpstate":"VA","pcpzip":"24523-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5405835149,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F29.","R44.1","Z86.59","Z20.822","R05.9","R09.81","S30.0XXA","M53.3","W10.8XXA","R03.0","R63.6","F17.210","J01.01","R44.0","F32.9","J01.00","J02.9","J20.9"],"date":["2023-09-20","2021-03-19","2021-03-19","2021-03-19","2022-04-15","2022-04-15","2022-11-14","2022-11-14","2022-11-14","2021-03-22","2021-03-22","2021-03-22","2022-04-03","2021-03-18","2021-03-20","2022-09-01","2022-09-01","2022-09-01"],"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":[["","00527331237","METHYLPHENID","TAB 36MG ER","30","Select","Select",""],["","55111016730","OLANZAPINE","15 MG","30","Select","Select",""],["","42806034101","AMPHET\/DEXTR","TAB 10MG","60","Select","Select",""],["","54092038501","ADDERALL XR","CAP 15MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","57844011001","ADDERALL","TAB 10MG","60","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","40","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","16714095001","DEXTROAMPHETAMINE-AMPHETAMINE","10 MG","60","Select","Select",""],["","80681008600","MELATONIN","3 MG","30","Select","Select",""],["","55111016730","OLANZAPINE TAB","15MG","30","Select","Select",""],["","00527331237","METHYLPHENID TAB","36MG ER","30","Select","Select",""],["","66993059602","AMPHET\/DEXTR CAP","15MG ER","30","Select","Select",""],["","54092038501","ADDERALL XR CAP","15MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","30","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","57844011001","ADDERALL TAB","10MG","60","Select","Select",""],["","42806034101","AMPHET\/DEXTR TAB","10MG","60","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","59746017509","PREDNISONE TAB","20MG","10","Select","Select",""],["","00143924920","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","70010077001","METHOCARBAM TAB","750MG","20","Select","Select",""],["","00591352530","LIDOCAINE PAD","5%","30","Select","Select",""],["","65162083366","DICLOFENAC GEL","1%","100","Select","Select",""],["","68645056259","IBUPROFEN TAB","600MG","40","Select","Select",""],["","31722070090","LOSARTAN POTASSIUM","25 MG","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":""}]}]}