{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERRY B LAW","gend":0,"add":"2929 RAVENWOOD AVE","city":"ROANOKE","state":"VA","zip":"24101-9998","dob":"1980-12-08","age":"","mstatus":"","insh":"20078375*01","cliId":"","pno":8044815979,"cno":8044815979,"email":"","ename":"","eno":"","pphy":"OWENS, ALEXANDRA PA","ppno":8047390910,"pcpadd":"13861 HULL STREET RD,","pcpcity":"MIDLOTHIAN","pcpstate":"VA","pcpzip":"23112-9998","pcpcounty":"","pcpid":"","pcpname":"Primary Health Group - Chippenham","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047392763,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F15.10","S00.01XA","M25.512","G40.909","M54.2","Z87.891","H10.33","T15.02XA","R10.9","N20.1","R31.9","F25.0","F43.10","F15.20","F41.9","F33.9","F19.94","F31.81","F33.1","N30.01","R10.31","Z53.29","K21.9","Z87.442","Z79.899"],"date":["2022-09-06","2021-10-21","2023-05-14","2023-05-14","2023-05-14","2023-05-14","2023-05-14","2022-12-26","2022-12-26","2023-05-19","2023-01-03","2023-01-03","2021-11-07","2021-11-07","2021-11-07","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-11-14","2023-05-19","2023-05-19","2023-05-19","2023-05-19","2023-05-19","2023-05-19"],"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":[["","12496030001","SUBLOCADE","INJ 300\/1.5","2","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","14","Select","Select",""],["","63402030630","LATUDA","TAB 60MG","30","Select","Select",""],["","58602077321","PAIN RELIEF","TAB 500MG","20","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","40","Select","Select",""],["","00093117401","PENICILLN VK","TAB 500MG","28","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","14","Select","Select",""],["","50428028552","ACETAMINOPHN","TAB 500MG","40","Select","Select",""],["","60505056000","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","31722053705","LEVETIRACETAM","500 MG","60","Select","Select",""],["","10702001801","OXYCODONE HCL","5 MG","12","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","10","Select","Select",""],["","57237001401","TAMSULOSIN HCL","0.4 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":""}]}]}