{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YNAFFITYLLEK M ","gend":1,"add":"UB 403RD RR","city":"RUTHER GLEN","state":"VA","zip":"22546-9998","dob":"1988-05-22","age":"","mstatus":"","insh":"0934610*74","cliId":"","pno":"44\/4082903-8","cno":"804\/448-3092","email":"","ename":"","eno":"","pphy":"PASCOE, CARRIE NP","ppno":"804\/633-5840","pcpadd":"121 COURTHOUSE LANE","pcpcity":"BOWLING GREEN","pcpstate":"VA","pcpzip":22427,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R40.20","F41.9","Z68.1","F11.20","F13.20","R94.5","R19.7","R11.2","A08.4","F32.9","Z20.822","V58.89","F11.14","M79.602","F12.20","F11.24","F11.288","F13.10","F12.10","F19.21","Z51.81","G47.9","F41.1","R50.9","R51.9","R11.10","R52.","E86.0","R00.0","R11.0","B34.9","F11.10","F39.","N93.9","F17.200","Z03.818","S33.5XXA","N39.9","R53.83","F13.230","R53.82","R63.4","NO DATA","T40.2X1A","F23.","I95.9","F17.210","F19.10","J01.90","Z11.52","R09.81"],"date":["2020-03-05","2022-06-27","2020-03-14","2020-11-23","2020-09-30","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2022-05-11","2022-02-22","2022-04-17","2020-03-19","2020-10-10","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2020-11-02","2022-05-11","2022-05-11","2022-05-11","2020-03-25","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2022-02-03","2020-03-24","2020-03-24","2022-01-27","2022-01-27","2022-02-22","2022-04-15","2022-01-27","2022-06-27","2022-06-27","2022-06-27","2022-06-27","2022-06-27","2020-03-05","2020-03-19","2020-03-19","2020-03-19","2020-03-19","2021-10-19","2022-01-14","2022-01-14"],"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":[["","10702001050","HYDROXYZ","TAB 10MG","30","Select","Select",""],["","00093321205","CLONAZEPAM","TAB 1MG","21","Select","Select",""],["","10370010250","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","65162018810","NAPROXEN","TAB 250MG","10","Select","Select",""],["","00115165903","PROPRANOLOL","TAB 10MG","90","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","12","Select","Select",""],["","68382003416","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00093224001","CEPHALEXIN","TAB 500MG","21","Select","Select",""],["","65862067899","ALPRAZOLAM","TAB 1MG","120","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","64980030760","DENTAGEL","GEL 0.011","56","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","15","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","210","Select","Select",""],["","69097083512","SERTRALINE","TAB 100MG","30","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","210","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","16729020001","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","00591354360","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","00093206301","QUETIAPINE","TAB 25MG","60","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":""}]}]}