{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KALPANABEN PATEL","gend":1,"add":"4520 GREENSBORO ROAD","city":"RIDGEWAY","state":"VA","zip":"24148-9998","dob":"1969-10-31","age":"","mstatus":"","insh":"2244781*01","cliId":"","pno":4196790199,"cno":4196790199,"email":"","ename":"","eno":"","pphy":"FAVERO JR, JOHN PATRICK DO","ppno":4345442315,"pcpadd":"650 N LEE HWY,","pcpcity":"LEXINGTON","pcpstate":"VA","pcpzip":"24450-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4343386313,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","E78.5","I10.","C50.412","C50.912","Z51.0","Z17.0","R76.8","R51.9","H25.813","H40.013","H40.023","M81.0","Z85.3","Z78.0","H52.4","E78.2","NO DATA","R92.2","G89.29","Z79.899"],"date":["2022-08-16","2022-08-16","2022-08-16","2022-12-21","2022-09-21","2022-11-01","2022-12-21","2022-02-28","2022-02-28","2021-10-20","2021-11-29","2022-05-05","2022-12-08","2022-12-08","2022-12-08","2021-10-20","2022-01-12","2022-08-16","2022-06-21","2022-08-16","2022-08-16"],"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":[["","31722070290","LOSARTAN POT","TAB 100MG","90","Select","Select",""],["","72205002790","ROSUVASTATIN","TAB 5MG","90","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","100","Select","Select",""],["","53885004601","ONETOUCH","KIT ULTRA 2","1","Select","Select",""],["","00093720110","PRAVASTATIN","TAB 20MG","30","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","180","Select","Select",""],["","68382005005","MELOXICAM","TAB 7.5MG","14","Select","Select",""],["","16729003516","ANASTROZOLE","TAB 1MG","90","Select","Select",""],["","59267030401","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","31722070290","LOSARTAN POT TAB","100MG","90","Select","Select",""],["","67877019705","AMLODIPINE TAB","2.5MG","30","Select","Select",""],["","00093505698","ATORVASTATIN TAB","10MG","30","Select","Select",""],["","65162019011","NAPROXEN TAB","500MG","180","Select","Select",""],["","68382005005","MELOXICAM TAB","7.5MG","14","Select","Select",""],["","68382020906","ANASTROZOLE TAB","1MG","26","Select","Select",""],["","59267030401","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","31722070290","LOSARTAN POTASSIUM","100 MG","90","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":""}]}]}