{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHAEL  D POFF","gend":0,"add":"2702 CUMBERLAND ST NW","city":"ROANOKE","state":"VA","zip":"24012-9998","dob":"1962-06-21","age":"","mstatus":"","insh":"2399182*01","cliId":"","pno":5403872598,"cno":5403872598,"email":"","ename":"","eno":"","pphy":"COUTURE, STEPHEN MD","ppno":5402832570,"pcpadd":"5304 INDIAN GRAVE RD","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":"24018-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5407254554,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z51.11","C91.10","Z00.6","Z09.","Z76.0","I10.","E78.5","Z85.6","K35.80","R53.83","R11.0","E87.5","R59.1","NO DATA","K80.20","I25.10","Z79.82","Z72.0","Z76.89","Z95.1","C95.91","C91.11","Z20.822","Z01.810","K37.","R10.9"],"date":["2022-04-18","2023-04-07","2023-04-07","2023-02-15","2023-02-15","2023-02-15","2023-02-15","2023-02-15","2022-11-15","2023-01-13","2021-12-13","2022-04-06","2022-04-06","2022-04-06","2022-04-06","2022-11-15","2022-11-15","2022-04-06","2022-08-15","2022-11-15","2022-08-15","2022-11-15","2022-11-15","2022-11-16","2022-11-18","2022-11-16"],"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":[["","00093505798","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","65862044830","VALACYCLOVIR","TAB 500MG","30","Select","Select",""],["","70954013610","DAPSONE","TAB 100MG","30","Select","Select",""],["","00074057622","VENCLEXTA","TAB 100MG","120","Select","Select",""],["","16714004211","ALLOPURINOL","TAB 300MG","30","Select","Select",""],["","57237007810","ONDANSETRON","TAB 8MG ODT","30","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","30","Select","Select",""],["","80777027315","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","90","Select","Select",""],["","00168035730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","49035056314","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","00093342601","LORAZEPAM","TAB 1MG","2","Select","Select",""],["","68462063945","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","80777028205","MODERNA BIVA","INJ BA4\/BA5","0","Select","Select",""],["","58160089052","FLUARIX QUAD","INJ 2022-23","0","Select","Select",""],["","49035056314","ASPIRIN EC","81 MG","30","Select","Select",""],["","68382013201","TAMSULOSIN HCL","0.4 MG","30","Select","Select",""],["","00093505798","ATORVASTATIN CALCIUM","80 MG","90","Select","Select",""],["","68462063945","NITROGLYCERIN","0.4 MG","25","Select","Select",""],["","43547028211","ESCITALOPRAM OXALATE","20 MG","30","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":""}]}]}