{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DAVID  S WILSON","gend":0,"add":"155 DOLITTLE ST","city":"DANVILLE","state":"VA","zip":"24541-9998","dob":"1968-11-29","age":"","mstatus":"","insh":"2033599*01","cliId":"","pno":4348572486,"cno":4348572486,"email":"","ename":"","eno":"","pphy":"TORRES, MICHAEL MD","ppno":4346561274,"pcpadd":"291 MCBRIDE LANE","pcpcity":"GRETNA","pcpstate":"VA","pcpzip":"24557-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CHARLOTTESVILLE WESTERN","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4346563405,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["A41.9","R50.82","I10.","E78.00","Z90.49","Z88.5","Z20.822","R11.2","K81.0","R09.81","R05.9","J01.90","F41.8","R50.9","E87.1","K80.00","E80.6","F41.9","G62.9","Z98.890","I25.2","Z82.49","Z88.0","Z79.899","R10.84"],"date":["2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-10-11","2022-01-09","2022-02-17","2022-02-17","2022-03-11","2022-10-13","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2022-10-10"],"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":[["","43598043611","NITROGLYCERN","SUB 0.4MG","100","Select","Select",""],["","57664016758","METOPROL TAR","TAB 100MG","60","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","12","Select","Select",""],["","00093321205","CLONAZEPAM","1 MG","60","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","5","Select","Select",""],["","49884012201","LABETALOL","TAB 100MG","60","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","70377000415","SIMVASTATIN","40 MG","90","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","10","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","3","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","3","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","68462038201","ESZOPICLONE","1 MG","30","Select","Select",""],["","57664016758","METOPROLOL TARTRATE","100 MG","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":""}]}]}