{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY   R SAWYERS","gend":1,"add":"129 WILSON AVE APT 8","city":"GALAX","state":"VA","zip":"24333-9998","dob":"1982-12-06","age":"","mstatus":"","insh":"20034575*01","cliId":"","pno":"276\/237-6054","cno":"276\/237-6054","email":"","ename":"","eno":"","pphy":"FOWLER, SCOTT M MD","ppno":"276\/236-5593","pcpadd":"SUITE 200A 104 CRANBERRY ROAD","pcpcity":"GALAX","pcpstate":"VA","pcpzip":24333,"pcpcounty":"","pcpid":170952,"pcpname":"SRMHMG - Sentara East Market Street Health Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"276\/266-0495","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/236-8084","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S00.83XA","V43.62XA","S02.5XXA","Z79.899","G40.909","K08.89","I10.","K21.9","F32.9","D50.9","N92.0","Z68.42","M54.9","X58.XXXA","J02.0","N39.0","S09.90XA","Z01.411","N76.1","E66.09","S29.011A","M54.6"],"date":["2020-02-18","2020-02-18","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-11-21","2021-06-24","2020-11-09","2020-02-10","2020-02-18","2021-04-13","2021-04-13","2021-04-13","2020-11-21","2020-11-21"],"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":[["","65862085901","FAMOTIDINE ","20MG","180","Select","Select",""],["","10702002510","PHENTERMINE ","37.5MG","30","Select","Select",""],["","55111012601","CIPROFLOXACN ","250MG","14","Select","Select",""],["","00093010910","CARBAMAZEPIN ","200MG","90","Select","Select",""],["","00591042405","TRIAMT\/HCTZ ","37.5-25","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","Select","Select",""],["","00378515091","NIZATIDINE ","150MG","60","Select","Select",""],["","50111064703","FLUOXETINE ","10MG","30","Select","Select",""],["","00378668910","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","76385012450","METHOCARBAM ","750MG","15","Select","Select",""],["","65862001501","AMOXICILLIN ","875MG","20","Select","Select",""],["","72578000801","METRONIDAZOL ","500MG","14","Select","Select",""],["","00406048401","APAP\/CODEINE ","300-30MG","15","Select","Select",""],["","69230030001","ALLERGY ","180MG","30","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20","Select","Select",""],["","57237004105","PENICILLN ","500MG","40","Select","Select",""],["","55111012601","CIPROFLOXACN","250MG","14","Select","Select",""],["","10702002510","PHENTERMINE","37.5MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","180","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","30","Select","Select",""],["","00904759080","FEROSUL","325MG","30","Select","Select",""],["","50111064703","FLUOXETINE","10MG","30","Select","Select",""],["","00093010910","CARBAMAZEPIN","200MG","90","Select","Select",""],["","00378515091","NIZATIDINE","150MG","60","Select","Select",""],["","00591042405","TRIAMT\/HCTZ","37.5-25","30","Select","Select",""],["","65862001501","AMOXICILLIN","875MG","20","Select","Select",""],["","76385012450","METHOCARBAM","750MG","15","Select","Select",""],["","00378668910","PANTOPRAZOLE","40MG","30","Select","Select",""],["","69230030001","ALLERGY","180MG","30","Select","Select",""],["","00406048401","APAP\/CODEINE","300-30MG","15","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","57237004105","PENICILLN","500MG","40","Select","Select",""],["","72578000801","METRONIDAZOL","500MG","14","Select","Select",""],["","47469005865","MELATONIN","5MG","30","Select","Select",""],["","65162068110","PHENAZOPYRID ","TAB 100MG","12","Select","Select",""],["","13668000905","CITALOPRAM ","TAB 10MG","30","Select","Select",""],["","47469005865","MELATONIN ","TAB 5MG","30","Select","Select",""],["","00185012201","NITROFURANTN ","CAP 100MG","10","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","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}