{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ENIREHTACRESUOH J  ","gend":1,"add":"LAW 461RD TUN","city":"BROADWAY","state":"VA","zip":"22815-9998","dob":"1988-06-27","age":"","mstatus":"","insh":"8821210*33","cliId":"","pno":"47\/0451507-6","cno":"540\/746-7051","email":"","ename":"","eno":"","pphy":"WRIGHT, MICHELLE C K NP","ppno":"540\/564-5622","pcpadd":"1790 E MARKET ST STE 64B","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":22801,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara East Market Street Health Center","plan":"OHP","program":"MEDICAID","lob":"M4","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":["L03.311","J22.","F31.32","F31.4","Z86.69","Z11.52","J20.9","R05.9","J34.89","G47.33","L03.90","G43.109","R11.2","F15.20","F17.210","Z20.822","R50.9","R07.9","R11.11","V62.84","R45.1","Z03.818","R09.81","R05.","J30.2","F13.20","F43.10","F32.9","F63.81","A41.9","J06.9","J45.21","R52.","R21.","R00.0","R60.9","T63.484A","Z68.42","T63.301A","E87.6","F31.9","J45.20","G43.909","E66.9","Z86.11","Z79.899","Z88.8","Z91.018","Z91.048","Z82.49","Z83.49","Z81.8","R06.02","J02.9","G43.119","R05.1"],"date":["2020-08-05","2021-09-20","2020-12-18","2021-11-04","2021-05-20","2021-11-11","2021-12-15","2021-12-15","2021-12-15","2020-03-24","2020-07-31","2021-04-20","2021-04-20","2021-12-01","2021-10-28","2021-10-28","2021-12-15","2021-12-15","2021-12-15","2020-12-18","2020-12-18","2020-12-18","2021-04-06","2021-05-03","2021-04-06","2021-12-01","2021-12-01","2021-12-01","2021-12-01","2020-08-05","2020-09-30","2020-09-30","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-07-31","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2020-08-02","2021-10-28","2021-04-29","2020-05-29","2021-10-28"],"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":[["","16714008110","HYDROXYZ","TAB 10MG","60","Select","Select",""],["","68462010905","TOPIRAMATE","TAB 100MG","28","Select","Select",""],["","43547028010","ESCITALOPRAM","TAB 5MG","14","Select","Select",""],["","68462026830","ATOMOXETINE","CAP 40MG","14","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","30","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","55111015430","ONDANSETRON","TAB 8MG","60","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","6","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","6","Select","Select",""],["","63824000850","MUCINEX","TAB 600MG ER","28","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","14","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","5","Select","Select",""],["","68462018022","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","55111053301","DIVALPROEX","TAB 250MG 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":""}]}]}