{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" IMOANNOSTAW","gend":1,"add":"NNIKCM 512TEERTS YE","city":"FREDERICKSBURG","state":"VA","zip":"22401-7122","dob":"1980-09-25","age":"","mstatus":"","insh":"50019131","cliId":"","pno":"0204537477","cno":5403688126,"email":"","ename":"","eno":"","pphy":"JONES, AMY E","ppno":5407411086,"pcpadd":"4535 SPOTSYLVANIA PKWY,","pcpcity":"Fredericksburg","pcpstate":"VA","pcpzip":"22408-7768","pcpcounty":"","pcpid":"","pcpname":"MARY WASHINGTON HEALTHCARE PHYSICIANS","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"215 MCKINNEY STREET","add3":"","madd1":"215 MCKINNEY STREET","madd2":"","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22401-7122","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.30","Z76.0","R10.32","R10.9","I10","G40.909","F17.210","Z86.03","Z98.2","F32.9","F09","F13.20","M54.5","L02.219","F20.9","D49.6","R56.9","G43.109","F17.200","F31.9","F41.9","Z79.899","M54.40","Z88.9","N20.0","G44.89","G93.9","R51.9","E66.9","E78.2","G47.00","J30.2","M54.16","M54.17","M62.838","G89.29","M54.81","F32.A","H93.92","Z01.419","Z12.31","Z11.3","R87.5","G91.1","G93.2","J98.8","R41.82","A41.9","G91.9","G93.40","D72.829","R82.71","S09.90XA","J96.00","M79.89","R09.02","Z46.82","R84.5","T50.901A","R50.9","J96.02","J16.8","R93.0","R03.0","Z20.822","Z01.818","Z46.59","Z86.69","R11.2","J15.211","Z45.2","Z98.890","B49","R11.14","B37.7","N39.0","Z51.89","R53.1","R13.10","G93.41","I12.9","N18.31","F41.8","M19.90","R41.89","B37.89","T85.618D"],"date":["2021-03-17","2021-03-17","2021-03-17","2023-05-10","2023-05-14","2023-05-20","2021-07-23","2021-03-17","2023-05-26","2022-09-12","2022-09-12","2022-09-12","2021-07-23","2021-07-23","2022-05-10","2023-05-13","2022-10-28","2021-10-04","2023-05-20","2023-05-20","2022-05-10","2021-08-26","2021-10-20","2021-08-24","2021-08-26","2022-07-21","2023-05-13","2023-05-13","2021-10-04","2022-08-16","2022-05-10","2021-10-04","2023-03-30","2022-02-11","2022-03-10","2023-03-30","2022-03-10","2022-05-10","2022-08-10","2022-08-10","2022-08-17","2022-08-16","2022-08-10","2023-05-13","2022-10-28","2023-03-30","2023-05-13","2023-05-13","2023-05-15","2023-05-05","2023-05-09","2023-05-12","2023-05-13","2023-04-22","2023-04-22","2023-04-22","2023-05-13","2023-05-12","2023-04-28","2023-05-09","2023-04-21","2023-04-21","2023-04-21","2023-04-21","2023-04-21","2023-05-13","2023-05-13","2023-05-04","2023-05-13","2023-05-20","2023-05-12","2023-05-13","2023-05-05","2023-05-05","2023-05-26","2023-05-12","2023-05-13","2023-05-13","2023-05-20","2023-05-20","2023-05-20","2023-05-20","2023-05-13","2023-05-20","2023-05-13","2023-05-13","2023-05-26"],"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":[["","51672402301","ACETAZOLAMID","TAB 250MG","90","Select","Select",""],["","65862024608","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","57237001890","DULOXETINE","CAP 30MG","60","Select","Select",""],["","65862022960","LAMOTRIGINE","TAB 150MG","30","Select","Select",""],["","65862049501","QUETIAPINE","TAB 400MG","30","Select","Select",""],["","50111056102","TRAZODONE","TAB 100MG","30","Select","Select",""],["","23155002405","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","00185067401","HYDROXYZ PAM","CAP 25MG","60","Select","Select",""],["","71093011105","GABAPENTIN","TAB 600MG","90","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","90","Select","Select",""],["","76385012450","METHOCARBAM","TAB 750MG","90","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","19515080852","FLULAVAL QUA","INJ 2022-23","0.5","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","15","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0.25","Select","Select",""],["","65862067601","ALPRAZOLAM","TAB 0.25MG","5","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","30","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","31722054201","INDOMETHACIN","CAP 25MG","60","Select","Select",""],["","68462029201","VERAPAMIL","TAB 120MG ER","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":""}]}]}