{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AH C   NONNAHSYELWARC-SNIKW","gend":1,"add":"AP 514EVA KR","city":"EMPORIA","state":"VA","zip":"23847-9998","dob":"1986-03-24","age":"","mstatus":"","insh":"3093110*05","cliId":"","pno":"02\/9191377-8","cno":"919\/208-7731","email":"","ename":"","eno":"","pphy":"ANDERSON, MICHAEL S MD","ppno":"434\/634-6101","pcpadd":"6 DOCTORS DRIVE","pcpcity":"EMPORIA","pcpstate":"VA","pcpzip":23847,"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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R26.2","S39.012S","F31.81","F41.9","M20.41","M77.50","M21.969","L85.1","M77.9","N92.0","Z32.02","N87.0","B97.7","M54.9","F33.0","Z20.828","F41.1","F31.9","L29.9","B34.9","M25.572","S00.03XA","R51.9","V89.2XXD","G56.01","Z01.419","R39.14","R39.15","M51.16","M47.22","M54.12","E88.81","Z20.822","E66.01","Z68.41","G43.909","E66.9","Z68.38","Z68.37","D64.9","K21.9","R42.","R51.0","Z13.6","E53.8","Z98.84","M54.5","M51.36","M50.30","M62.838","M47.812","NO DATA","F31.32","R10.13","M25.511","Z68.35","M54.2","S49.92XA","Z79.3","Z82.49","Z83.3","Z88.5","E66.09","K30.","Z98.0","Z04.9","U07.1","R05.8","M25.541","M79.621","R45.89","J02.0","R05.","J30.9","L29.8","R27.8","J35.01","J35.1","Z68.34","M54.6","V89.2XXA","Z01.411","Z11.3","N94.19","M25.531","J02.8"],"date":["2021-07-15","2020-01-15","2022-07-29","2022-08-19","2020-10-22","2020-10-22","2020-10-22","2020-09-25","2020-09-25","2022-04-22","2021-01-21","2021-01-21","2021-01-21","2021-07-15","2020-12-28","2021-03-08","2022-07-29","2022-07-29","2020-08-25","2020-09-10","2020-09-15","2021-05-17","2021-05-17","2021-05-17","2021-10-24","2022-03-18","2022-03-18","2022-03-18","2022-04-04","2022-04-04","2022-04-04","2022-07-21","2022-10-31","2022-08-19","2022-08-19","2022-08-19","2020-01-23","2020-09-18","2021-09-29","2022-05-08","2022-05-08","2020-10-28","2020-10-28","2020-10-28","2020-11-17","2022-08-19","2021-09-29","2021-10-22","2022-03-15","2021-09-13","2022-03-15","2022-02-25","2022-06-27","2022-08-19","2021-01-15","2021-02-01","2022-03-15","2022-05-08","2022-05-08","2022-05-08","2022-05-08","2022-05-08","2022-05-08","2022-08-19","2022-08-19","2022-08-19","2022-11-07","2022-11-07","2021-10-24","2021-10-24","2022-01-21","2020-08-03","2020-08-03","2020-09-18","2020-09-22","2020-09-03","2021-02-23","2021-02-23","2021-02-23","2020-02-10","2020-02-10","2020-12-23","2020-12-23","2020-12-23","2021-10-24","2022-10-31"],"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":[["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","60","Select","Select",""],["","00093206301","QUETIAPINE","TAB 25MG","90","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","10702002501","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","1","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","CAP ","18","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","68462030929","NORGEST\/ETHI","TAB 0.25\/35","84","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","74312003860","VITAMIN","SUB 2500MCG","30","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","21","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","68180086473","BLISOVI","TAB FE 1\/20","28","Select","Select",""],["","50742065601","CARISOPRODOL","TAB 350MG","21","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","30","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","42","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","60","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","51672130406","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","13668000905","CITALOPRAM","TAB 10MG","90","Select","Select",""],["","50383080116","PROMETHAZINE","SYP 6.25\/5ML","100","Select","Select",""],["","50428039731","ANTI-ITCH","LOT 0.5-0.5%","222","Select","Select",""],["","49502050002","EPIPEN","INJ 0.3MG","2","Select","Select",""],["","52817031910","BACLOFEN","TAB 5MG","30","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","20","Select","Select",""],["","43547030303","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","50428051206","CVS","SUB B12","60","Select","Select",""],["","65162044110","MECLIZINE","TAB 12.5MG","30","Select","Select",""],["","40985027113","B-12","SUB 5000MCG","30","Select","Select",""],["","69097012203","TOPIRAMATE","TAB 25MG","30","Select","Select",""],["","55111029336","SUMATRIPTAN","TAB 100MG","9","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":""}]}]}