{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBECCA SANTIAGO","gend":1,"add":"1017 DEWBERRY DRIVE                                         ","city":"FREDERICKSBURG                ","state":"VA","zip":"22407-4885","dob":"1999-09-10","age":"","mstatus":"","insh":4357025,"cliId":"","pno":5409935708,"cno":"","email":"","ename":"","eno":"","pphy":"STINAR, THERON R","ppno":5407858500,"pcpadd":"1129 Heatherstone Dr,","pcpcity":"Fredericksburg                ","pcpstate":"VA","pcpzip":224074828,"pcpcounty":"","pcpid":"","pcpname":"FREDERICKSBURG CHRISTIAN HEALTH CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"                                                            ","add3":"","madd1":"1017 DEWBERRY DRIVE","madd2":"                                                            ","madd3":"","mcity":"FREDERICKSBURG                ","mstate":"VA","mzip":"22407-4885","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","Z79.899","N63.20","R11.0","F41.3","N63.22","N60.22","N60.32","N63.24","R92.8","Z09","N60.39","J02.9","H60.503","H66.93","A08.4","Z11.52","J06.9","J20.9","R05","K21.9","Z23","Z20.828","R06.00","U07.1"],"date":["2021-06-04","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-23","2021-07-23","2021-07-23","2021-12-31","2021-08-24","2021-08-24","2021-09-12","2021-09-12","2021-09-13","2021-12-31","2021-09-13","2021-11-15","2021-12-18","2021-12-22","2021-12-31","2021-12-31"],"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":[["","50111064701","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","15","Select","Select",""],["","16729020201","BUSPIRONE","TAB 10MG","240","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","53489011905","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","65162068090","PROMETHAZINE","SOL DM","120","Select","Select",""],["","60505036301","OFLOXACIN","DRO 0.3%OTIC","5","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","10","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","50","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":""}]}]}