{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRITTNEY HAMILTON","gend":1,"add":"105 LITCHFIELD ST NW APT F142","city":"COEBURN","state":"VA","zip":"24230-9998","dob":"1987-01-26","age":"","mstatus":"","insh":"1830960*01","cliId":"","pno":"276\/298-6287","cno":"276\/298-6287","email":"","ename":"","eno":"","pphy":"BEVINS, ASHLEY DO","ppno":"276\/328-8910","pcpadd":"716 SPRING AVE SE SUITE 204","pcpcity":"WISE","pcpstate":"VA","pcpzip":24293,"pcpcounty":"","pcpid":152191,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","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":["F33.9","R10.84","N83.201","R94.4","R11.2","R19.7","R10.2","Z79.899","N93.9","R10.30","F41.9","Z87.891","Z30.46","N91.2","N89.8","R10.31","N39.0","R22.0"],"date":["2020-10-05","2020-11-22","2020-12-24","2020-12-24","2020-12-24","2020-12-24","2021-01-20","2020-05-27","2020-10-19","2020-10-19","2020-05-14","2020-05-14","2021-01-20","2021-01-20","2021-01-20","2020-12-31","2020-12-31","2021-01-13"],"priorHcc":["","","","","","","","","","","","","","","","","",""]}},{"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":[["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","00591024005","LORAZEPAM ","0.5MG","30","Select","Select",""],["","50111064701","FLUOXETINE ","10MG","30","Select","Select",""],["","57237000830","MIRTAZAPINE ","15MG","30","Select","Select",""],["","64380074107","BUSPIRONE ","5MG","90","Select","Select",""],["","68462039710","OMEPRAZOLE ","40MG","30","Select","Select",""],["","68462015713","ONDANSETRON ","4MG ODT","12","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","68462013801","OXCARBAZEPIN ","300MG","30","Select","Select",""],["","61442010301","DICLOFENAC ","75MG DR","60","Select","Select",""],["","29300012410","MELOXICAM ","7.5MG","30","Select","Select",""],["","67405065105","DOXYCYCL ","100MG","20","Select","Select",""],["","65162062711","TRAMADOL ","50MG","6","Select","Select",""],["","42571025101","CLINDAMYCIN ","150MG","80","Select","Select",""],["","51672130406","TERCONAZOLE ","0.40%","45","Select","Select",""],["","59746017509","PREDNISONE ","20MG","10","Select","Select",""],["","55111068405","IBU ","800MG","15","Select","Select",""],["","68001036103","MONTELUKAST ","10MG","30","Select","Select",""],["","00591555510","PROPRANOLOL ","20MG","60","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","68462039710","OMEPRAZOLE","40MG","30","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","50111064801","FLUOXETINE","20MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00591024005","LORAZEPAM","0.5MG","14","Select","Select",""],["","00093005301","BUSPIRONE","5MG","60","Select","Select",""],["","57237000830","MIRTAZAPINE","15MG","30","Select","Select",""],["","68462013801","OXCARBAZEPIN","300MG","30","Select","Select",""],["","67405065105","DOXYCYCL","100MG","20","Select","Select",""],["","29300012410","MELOXICAM","7.5MG","30","Select","Select",""],["","61442010301","DICLOFENAC","75MG DR","60","Select","Select",""],["","65162062711","TRAMADOL","50MG","6","Select","Select",""],["","68462015713","ONDANSETRON","4MG ODT","12","Select","Select",""],["","42571025101","CLINDAMYCIN","150MG","80","Select","Select",""],["","59746017509","PREDNISONE","20MG","10","Select","Select",""],["","51672130406","TERCONAZOLE","0.40%","45","Select","Select",""],["","55111068405","IBU","800MG","15","Select","Select",""],["","68001036103","MONTELUKAST","10MG","30","Select","Select",""],["","00591555510","PROPRANOLOL","20MG","60","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":""}]}]}