{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARY HAYZLETT","gend":1,"add":"95   BROOKSHIRE LANE                                        ","city":"BASSETT                       ","state":"VA","zip":"24055-3347","dob":"1987-07-08","age":"","mstatus":"","insh":4522314,"cliId":"","pno":2763405977,"cno":"","email":"","ename":"","eno":"","pphy":"HAQ, AHMAD                                                  ","ppno":3366239711,"pcpadd":"4055 Valley View Ln Ste 400                                 ,                                                            ","pcpcity":"Dallas                        ","pcpstate":"TX","pcpzip":752445071,"pcpcounty":"","pcpid":"","pcpname":"BASSETT FAMILY PRACTICE","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"95   BROOKSHIRE LANE                                        ","add3":"","madd1":"95   BROOKSHIRE LANE                                        ","madd2":"APT 7                                                       ","madd3":"","mcity":"BASSETT                       ","mstate":"VA","mzip":"24055-3347","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["D59.3","H52.203","H04.123","S29.019A","N18.1","I10","E05.90","E04.1","J06.9","Z20.828","M54.2","M54.5","R07.89","Z71.89","Z71.3","F41.8","N18.30","R53.1","R29.3","R30.0","R06.83","Z13.220","Z00.00","D72.829","Z79.899","G47.33","G47.30","N18.2","D64.9","A08.4","K21.9","Z13.6","E78.5","R61","S29.012A","F41.9","K59.00","R11.2","G47.00","R20.0","F17.210","R63.8","R19.7","R94.31","R07.9","R11.10","R39.9","G47.9","F41.1","F33.1"],"date":["2021-10-07","2020-01-20","2020-01-20","2020-03-06","2020-05-28","2022-03-03","2022-03-03","2021-05-21","2020-07-09","2022-03-01","2021-02-15","2021-02-15","2022-03-01","2022-04-28","2022-04-28","2022-02-28","2022-01-25","2021-02-15","2021-02-15","2021-03-25","2021-05-18","2021-03-29","2021-03-30","2021-03-30","2022-04-28","2021-05-18","2021-06-03","2021-10-07","2021-10-07","2022-01-24","2022-01-24","2022-01-25","2022-03-03","2022-02-28","2022-02-28","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-03","2022-03-03","2022-04-28","2022-03-16"],"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":[["","68180051303","LISINOPRIL","TAB 5MG","60","Select","Select",""],["","13668000905","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","49884064001","METHIMAZOLE","TAB 5MG","15","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","69584009150","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","63824005636","MUCINEX","TAB 30-600ER","10","Select","Select",""],["","00115166202","PROPRANOLOL","TAB 80MG","60","Select","Select",""],["","68382003416","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","65862007601","CIPROFLOXACN","TAB 250MG","10","Select","Select",""],["","50428029464","CVS","TAB 8.6-50MG","60","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","00093117210","PENICILLN","TAB 250MG","120","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","20","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":""}]}]}