{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DIRK WAINWRIGHT","gend":0,"add":"184 SOUTH GENITO ROAD","city":"BURKEVILLE","state":"VA","zip":"23922-9998","dob":"1966-10-09","age":"","mstatus":"","insh":"20085241*01","cliId":"","pno":4346770664,"cno":4346770664,"email":"","ename":"","eno":"","pphy":"KSIONSKI, SEBASTIAN MD","ppno":4343155340,"pcpadd":"935 S MAIN ST","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":"23901-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342001679,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I49.5","M25.551","R26.2","M62.81","I47.1","K70.31","N17.9","E87.6","D64.9","R60.0","R06.09","M79.605","K74.60","R16.0","Z72.0","C22.9","K70.30","I95.9","D50.9","K59.00","K64.8","K21.9","F10.10","Z79.899","Z79.891","Z87.891","Z91.81","Z68.26","L02.211","R10.9","R10.84","K65.1","NO DATA","C7A.8","C78.6","C7A.019","R18.8","J90.","D63.8","R18.0","M76.30","R25.2","D3A.00","D3A.8","D72.819","F12.90","G89.3","Z51.5","Z80.9","Z82.49","Z71.89","R11.0","Z68.23","Z68.22","Z74.3","I34.0","I51.7","Z68.25","R00.1","I48.91","Z68.21","Z91.018","K70.2","Z95.0","Z68.1","E87.3","R11.2","R53.1","K31.5","Z68.20","C7A.020","R06.00","C80.0","K55.069","I44.2","F43.23","G47.00"],"date":["2023-04-07","2023-01-04","2023-01-04","2023-01-04","2023-01-14","2023-04-08","2023-01-16","2023-04-17","2023-01-16","2023-01-10","2022-08-22","2022-08-22","2023-04-08","2022-08-22","2022-08-22","2022-10-11","2023-01-10","2022-10-11","2023-04-18","2023-01-13","2022-10-11","2023-04-18","2022-10-11","2023-01-10","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2023-01-07","2023-01-07","2023-04-21","2023-01-16","2023-04-12","2023-04-14","2023-04-19","2023-04-19","2023-04-09","2023-01-17","2023-01-12","2023-04-07","2022-12-19","2022-12-19","2023-01-10","2023-04-18","2023-01-10","2023-01-10","2023-04-21","2023-04-21","2023-01-10","2023-01-10","2023-04-21","2023-01-12","2023-01-13","2023-01-10","2023-01-10","2023-01-11","2023-01-11","2023-01-14","2023-04-17","2023-02-20","2023-02-20","2023-02-20","2023-02-20","2023-04-07","2023-04-13","2023-04-17","2023-04-17","2023-04-21","2023-04-18","2023-04-21","2023-04-19","2023-04-06","2023-04-09","2023-04-09","2023-04-06","2022-09-21","2022-09-21"],"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":[["","00245531911","KLOR-CON M20","TAB 20MEQ ER","30","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00245021211","MIDODRINE","TAB 5MG","90","Select","Select",""],["","51991082428","EVEROLIMUS","10 MG","28","Select","Select",""],["","43547040211","FUROSEMIDE","40 MG","30","Select","Select",""],["","42858030101","HYDROMORPHON","TAB 2MG","60","Select","Select",""],["","69097081312","GABAPENTIN","100 MG","90","Select","Select",""],["","53746051501","SPIRONOLACT","TAB 100MG","60","Select","Select",""],["","10702005601","OXYCODONE HCL","10 MG","90","Select","Select",""],["","00121087316","LACTULOSE","10 G\/15 ML","946","Select","Select",""],["","42858030101","HYDROMORPHONE HCL","2 MG","30","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","53746051101","SPIRONOLACTONE","25 MG","30","Select","Select",""],["","00245531911","KLOR-CON M","20 20 MEQ","30","Select","Select",""],["","00378912298","FENTANYL","50MCG\/HR","10","Select","Select",""],["","00093220401","METOCLOPRAMIDE HCL","5 MG","30","Select","Select",""],["","12843039324","PHILLIPS' MILK OF MAGNESIA","400 MG\/5ML","354","Select","Select",""],["","00536100715","CAL-GEST","200(500)MG","150","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":""}]}]}