{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEVON  A GORDON","gend":0,"add":"14741 DEMING DR APT 104","city":"GAINESVILLE","state":"VA","zip":"20155-9998","dob":"1960-11-15","age":"","mstatus":"","insh":"2275026*01","cliId":"","pno":5403167267,"cno":5403167267,"email":"","ename":"","eno":"","pphy":"TANG, STEVEN J MD","ppno":7037539799,"pcpadd":"SUITE 104 14540 JOHN MARSHALL HWY","pcpcity":"GAINESVILLE","pcpstate":"VA","pcpzip":"20155-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7037539792,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.9","R16.0","R93.5","R10.10","R93.3","Z79.899","C16.3","T07.XXXA","S09.90XA","R51.9","M54.2","V89.2XXA","Z45.2","Z13.29","Z51.11","C22.7","C77.2","K76.9","C78.7","R63.4","Z68.1","Z51.12","Z95.828","C16.9","S13.4XXA","S22.32XA","K31.89","C22.9","R10.13","R74.8","R63.0","K59.09","K21.9","K76.89","Z87.891","R43.2","R74.01","G62.0","R10.84","D64.9","R19.5","G62.9","R20.0","R44.8","Z96.89"],"date":["2022-11-14","2023-02-16","2022-10-28","2022-10-28","2022-11-15","2023-04-21","2023-04-21","2022-12-21","2022-12-22","2022-12-22","2022-12-22","2022-12-22","2023-04-21","2023-04-19","2023-04-19","2022-11-01","2022-11-01","2022-11-01","2023-04-05","2023-01-11","2023-01-11","2023-03-01","2023-03-01","2022-12-22","2022-12-22","2023-02-06","2022-11-01","2022-12-22","2023-04-05","2022-10-31","2022-10-31","2022-10-31","2022-10-31","2022-10-28","2023-04-05","2023-04-05","2023-04-05","2023-03-22","2022-10-28","2022-10-28","2022-10-28","2023-04-05","2023-04-05","2023-04-05","2023-03-22"],"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":[["","59676058015","JANSSEN VACC","INJ COVID-19","0","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","30","Select","Select",""],["","00168035730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","60","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","28","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","28","Select","Select",""],["","68180065208","DOXYCYC MONO","CAP 100MG","28","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","32","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","56","Select","Select",""],["","70954068810","PROCHLORPER","TAB 5MG","30","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","00054418425","DEXAMETHASONE","4 MG","32","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":""}]}]}