{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GINA   M CLAR","gend":1,"add":"307 ELLERY COURT","city":"FREDERICKSBURG","state":"VA","zip":"22408-2542","dob":"1986-12-18","age":"","mstatus":"","insh":4699301,"cliId":"","pno":5404191398,"cno":"","email":"","ename":"","eno":"","pphy":"GUIRGUIS, EKRAM G","ppno":5407365043,"pcpadd":"4370 Starkey Rd, Ste 4A","pcpcity":"Roanoke","pcpstate":"VA","pcpzip":240180603,"pcpcounty":"","pcpid":"","pcpname":"MARY WASHINGTON HEALTHCARE PHYSICIANS","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"307 ELLERY COURT","madd2":"","madd3":"","mcity":"FREDERICKSBURG","mstate":"VA","mzip":"22408-2542","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","J45.50","R21","R03.0","J44.9","L95.9","M25.50","K22.70","K21.9","Z98.890","Z80.0","E66.01","G47.30","I10","J45.909","Z68.42","Z79.51","Z87.891","M31.0","T07.XXXA","D48.5","D69.0","L03.115","M79.661","M77.31","I77.6","Z68.43","E28.2","Z82.3","Z82.49","Z83.3","J45.20","S81.801A","R10.33","Z79.52","L97.819","F17.290","I87.2","L97.812","L97.919","M79.606","S91.001D","F41.9","J30.9","M79.671","R35.0","D50.9"],"date":["2022-03-09","2021-11-18","2021-05-09","2021-05-08","2021-07-22","2021-07-21","2021-05-12","2021-07-29","2021-07-22","2021-06-14","2021-06-14","2021-07-22","2021-06-14","2021-06-14","2021-06-14","2021-06-14","2021-07-22","2021-07-22","2021-08-17","2021-06-16","2021-06-16","2021-12-09","2021-07-23","2021-07-21","2021-07-21","2021-08-19","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-07-22","2021-08-17","2021-07-29","2021-07-29","2021-08-05","2021-08-19","2021-09-03","2021-08-19","2021-08-26","2021-09-02","2021-09-03","2022-04-05","2022-04-05","2022-04-05","2022-04-05","2022-04-05"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00186037020","SYMBICORT","AER 160-4.5","10.2","Select","Select",""],["","00378827052","ALBUTEROL","NEB 0.00083","525","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","120","Select","Select",""],["","68382025601","OXYBUTYNIN","TAB 10MG ER","30","Select","Select",""],["","70710113803","FLUCONAZOLE","TAB 100MG","7","Select","Select",""],["","00555902542","JUNEL","TAB ","21","Select","Select",""],["","00173071720","ADVAIR","AER 230\/21","12","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","70000052102","OMEPRAZOLE","TAB 20MG DR","30","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","33342032980","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","51672130803","CLOTRIM\/BETA","LOT DIPROP","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","15","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","68180012101","CEPHALEXIN","CAP 250MG","28","Select","Select",""],["","42806016105","HYDROXYZ","TAB 50MG","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":""}]}]}