{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ACISSEJTNAYRB M ","gend":1,"add":"LGNAT 69RD DOOWE","city":"MARTINSVILLE","state":"VA","zip":"24112-9998","dob":"1977-06-21","age":"","mstatus":"","insh":"40500210*07","cliId":"","pno":"16\/6723771-8","cno":"276\/618-1773","email":"","ename":"","eno":"","pphy":"PHELPS, JENNIFER WALKER FNP","ppno":"276\/956-1629","pcpadd":"4944 GREENSBORO ROAD","pcpcity":"RIDGEWAY","pcpstate":"VA","pcpzip":24148,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","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":["F11.20","F31.9","F15.10","K21.9","N39.0","R11.2","R50.9","Z20.822","F17.210","R10.9","R05.9","J01.01","R09.81","F31.0","V62.84","F32.9","F41.9","R11.0","T78.40XA","F15.93","R21.","T43.625A","F17.200","F12.90","F11.90","F33.9","Z86.19","Z88.8","F31.64","Z23.","F42.4","L29.9","Z71.89","Z71.3"],"date":["2022-08-11","2020-05-27","2021-08-02","2020-05-24","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2021-10-27","2022-04-26","2022-04-26","2022-04-26","2022-07-28","2022-07-22","2022-07-22","2020-06-03","2020-06-03","2021-06-20","2021-06-20","2021-08-02","2020-03-14","2020-03-14","2020-03-14","2020-03-14","2020-03-14","2020-03-14","2020-03-14","2021-08-05","2020-10-16","2020-04-14","2020-04-14","2020-04-14","2020-04-14"],"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":[["","12496120803","SUBOXONE","MIS 8-2MG","14","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","56","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","20","Select","Select",""],["","43547034206","RISPERIDONE","TAB 2MG","60","Select","Select",""],["","13668004501","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","59651017601","DOXEPIN","CAP 75MG","30","Select","Select",""],["","88395014110","VITAMIN","CAP 5000UNIT","90","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","43547030403","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","12547017021","BENADRYL","CAP 25MG","30","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","20","Select","Select",""],["","00009002001","MEDROL","TAB 2MG","28","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","51991029301","OXCARBAZEPIN","TAB 300MG","60","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","14539067401","HYDROXYZ","CAP 25MG","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":""}]}]}