{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMARA   R STOTT","gend":1,"add":"431 MAYE JOHNSON LN","city":"KENBRIDGE","state":"VA","zip":"23944-9998","dob":"1982-08-25","age":"","mstatus":"","insh":"1280083*01","cliId":"","pno":"434\/234-2627","cno":"434\/234-2627","email":"","ename":"","eno":"","pphy":"AHMED, IRSHAD MD","ppno":"804\/524-0524","pcpadd":"STE B 2801 BOULEVARD","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":23834,"pcpcounty":"","pcpid":119469,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/524-0520","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.12","F33.2","Z79.899","Z87.898","Z72.0","L40.4","L29.8","M25.50","S93.402A","F17.210","W19.XXXA","L85.3","R50.9","Z03.818","M25.571","Z31.82","Z3A.28","Z23.","Z3A.33","Z53.9"],"date":["2020-10-20","2020-10-20","2020-11-16","2020-10-20","2020-10-20","2021-03-04","2021-03-04","2021-03-04","2021-03-10","2021-03-10","2021-03-10","2020-11-16","2020-08-06","2020-08-06","2021-03-10","2021-08-06","2021-08-06","2021-09-14","2021-09-14","2021-10-07"],"priorHcc":["","","","","","","","","","","","","","","","","",null,null,null]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68001018000","QUETIAPINE ","50MG","30","Select","Select",""],["","68382080605","TRAZODONE ","100MG","45","Select","Select",""],["","13668001105","CITALOPRAM ","40MG","30","Select","Select",""],["","00093083205","CLONAZEPAM ","0.5MG","60","Select","Select",""],["","00078063941","COSENTYX ","300DOSE","2","Select","Select",""],["","65862001905","CEPHALEXIN ","500MG","20","Select","Select",""],["","68382018101","BUSPIRONE ","10MG","60","Select","Select",""],["","57894064011","TREMFYA ","100MG\/ML","1","Select","Select",""],["","68001032205","BUPROPN ","150MG XL","30","Select","Select",""],["","16714076301","CALCIPOTRIEN ","0.01%","120","Select","Select",""],["","00121075908","PREDNISOLONE ","15MG\/5ML","60","Select","Select",""],["","45802006405","TRIAMCINOLON ","0.10%","454","Select","Select",""],["","00054350049","LIDOCAINE ","2% VISC","100","Select","Select",""],["","00143988701","AMOXICILLIN ","400\/5ML","200","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","60432060416","PROMETHAZINE ","DM","120","Select","Select",""],["","70710123304","BETAMETH ","0.05%","45","Select","Select",""],["","64380080807","IBUPROFEN ","600MG","9","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","57237007530","ONDANSETRON ","4MG","6","Select","Select",""],["","63044020301","IFEREX ","","60","Select","Select",""],["","68382018101","BUSPIRONE","10MG","60","Select","Select",""],["","00093083205","CLONAZEPAM","0.5MG","60","Select","Select",""],["","00078063941","COSENTYX","300DOSE","2","Select","Select",""],["","68382080605","TRAZODONE","100MG","45","Select","Select",""],["","13668001105","CITALOPRAM","40MG","30","Select","Select",""],["","68001018000","QUETIAPINE","50MG","30","Select","Select",""],["","68001032205","BUPROPN","150MG XL","30","Select","Select",""],["","45802006405","TRIAMCINOLON","0.10%","454","Select","Select",""],["","65862001905","CEPHALEXIN","500MG","20","Select","Select",""],["","57894064011","TREMFYA","100MG\/ML","1","Select","Select",""],["","16714076301","CALCIPOTRIEN","0.01%","60","Select","Select",""],["","00121075908","PREDNISOLONE","15MG\/5ML","60","Select","Select",""],["","00054350049","LIDOCAINE","2% VISC","100","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","60432060416","PROMETHAZINE","DM","120","Select","Select",""],["","70710123304","BETAMETH","0.05%","45","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","57237007530","ONDANSETRON","4MG","6","Select","Select",""],["","63044020301","IFEREX","","60","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","00143988701","AMOXICILLIN","400\/5ML","200","Select","Select",""],["","64380080807","IBUPROFEN","600MG","9","Select","Select",""],["","42858010250","OXYCOD\/APAP ","TAB 5-325MG","20","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}