{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN PENDLETON","gend":0,"add":"305 S FRANKLIN ST","city":"CHRISTIANSBURG","state":"VA","zip":"24073-9998","dob":"1984-06-01","age":"","mstatus":"","insh":"2358504*01","cliId":"","pno":7576186993,"cno":7576186993,"email":"","ename":"","eno":"","pphy":"THOMAS II, WILLIAM D DO","ppno":5403826148,"pcpadd":"6 HICKOK STREET","pcpcity":"CHRISTIANSBURG","pcpstate":"VA","pcpzip":"24073-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5403824191,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E16.1","E16.2","R40.4","R56.9","R09.02","R56.00","R00.0","R41.82","F10.10","K70.0","K70.9","R74.8","E10.10","Z72.0","Z13.220","G40.909","R11.2","S09.90XA","E10.65","Z79.4","R74.01","E80.6","E11.9","S01.01XA","R51.9","R09.1","NO DATA","Z20.822","Z09.","F33.3","R11.0","W19.XXXA","Z96.41","F10.20","M54.9","E10.9","I25.2","R94.31","Z76.89","G40.301","Z72.89","R16.0","R58.","R52.","R41.0","E10.649","G40.409","E83.51","Z87.891","T85.694A","N17.9","E86.0","J45.909","K76.0","Z23.","E11.65","S00.03XA","W22.8XXA","Z48.02","R79.89","F10.239","R57.8","R57.9"],"date":["2021-05-31","2021-05-31","2021-12-16","2021-12-23","2021-06-16","2021-12-23","2023-02-22","2021-12-23","2023-02-20","2022-05-24","2022-05-24","2022-05-24","2022-12-01","2022-08-09","2022-08-09","2023-02-20","2022-10-20","2022-10-20","2023-04-25","2023-04-20","2021-04-11","2021-04-11","2021-12-16","2021-12-16","2021-12-16","2022-01-08","2022-10-20","2022-10-20","2022-05-09","2022-05-09","2021-06-16","2021-06-16","2023-03-15","2021-12-23","2022-01-08","2022-02-09","2022-10-20","2022-10-20","2022-02-09","2022-02-09","2021-12-02","2021-12-02","2021-12-16","2021-12-16","2021-12-16","2022-10-20","2021-12-23","2021-12-23","2021-12-23","2022-10-20","2022-05-02","2021-04-10","2021-04-10","2021-04-10","2021-04-10","2021-05-31","2021-12-16","2021-12-16","2023-02-22","2021-05-31","2022-05-02","2022-05-02","2022-05-02"],"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":[["","00603188016","LIDOCAINE","PAD 0.05","4","Select","Select",""],["","00002751001","HUMALOG","100\/ML","30","Select","Select",""],["","00548585000","GLUCAGON","KIT 1MG","1","Select","Select",""],["","68462067960","LACOSAMIDE","100 MG","60","Select","Select",""],["","69584068450","PRIMIDONE","50 MG","90","Select","Select",""],["","31722053805","LEVETIRACETA","TAB 750MG","90","Select","Select",""],["","00131247835","VIMPAT","100 MG","60","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","15","Select","Select",""],["","00005556819","CALTRATE 600","CHW 600-800","30","Select","Select",""],["","90166043154","PEN NEEDLES","MIS 32GX4MM","100","Select","Select",""],["","08290320122","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","15","Select","Select",""],["","31722053805","LEVETIRACETAM","750 MG","90","Select","Select",""],["","73070010315","INSULIN ASPART FLEXPEN","100\/ML (3)","15","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":""}]}]}