{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAYLER STERN","gend":1,"add":"495 FALCON ST","city":"PRINCE GEORGE","state":"VA","zip":"23875-9998","dob":"2003-07-21","age":"","mstatus":"","insh":"20035602*01","cliId":"","pno":"804\/255-8600","cno":"804\/255-8600","email":"","ename":"","eno":"","pphy":"GONZALES, PATRICIA D MD","ppno":"804\/520-6137","pcpadd":"210 NORTH TEMPLE AVE","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":23834,"pcpcounty":"","pcpid":110095,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/541-1396","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R09.81","B34.9","E28.2","L68.0","E78.89","E66.9","R74.8","R63.5","I15.8","Z68.51","F90.2","F41.8","F34.1","M54.6","M54.9","J45.998","E55.9","K58.0","Z68.41","M54.5","M79.672","M40.204","M21.722","M40.294","L70.9"],"date":["2020-03-13","2020-03-13","2021-09-17","2021-05-13","2021-09-17","2021-05-13","2021-05-13","2021-05-13","2020-09-30","2021-05-13","2021-10-14","2021-10-14","2021-07-14","2020-09-25","2020-09-25","2020-05-28","2021-09-17","2021-09-17","2021-09-17","2020-03-25","2020-03-25","2020-03-25","2020-03-25","2020-07-23","2020-03-25"],"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":[["","50111064701","FLUOXETINE","10MG","30","Select","Select",""],["","00555902658","JUNEL","Jan-20","28","Select","Select",""],["","68180032002","BUPROPN","300MG XL","30","Select","Select",""],["","27241009706","DULOXETINE","20MG","30","Select","Select",""],["","29300013601","CLONIDINE","0.2MG","30","Select","Select",""],["","51224012230","AZITHROMYCIN","500MG","5","Select","Select",""],["","53746051101","SPIRONOLACT","25MG","90","Select","Select",""],["","64380080807","IBUPROFEN","600MG","90","Select","Select",""],["","08373982700","OPTICHAMBER","DIA LG","1","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","68462010530","ONDANSETRON","4MG","18","Select","Select",""],["","00054001925","PREDNISONE","50MG","5","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","63402030230","LATUDA","20MG","30","Select","Select",""],["","33332032001","AFLURIA","2020-21","0","Select","Select",""],["","64764073030","TRINTELLIX","10MG","30","Select","Select",""],["","68462013701","OXCARBAZEPIN","150MG","60","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","69452015120","VITAMIN","50000UNT","12","Select","Select",""],["","50111064701","FLUOXETINE ","CAP 10MG","30","Select","Select",""],["","00555902658","JUNEL ","TAB 43831","28","Select","Select",""],["","68180032002","BUPROPN ","TAB 300MG XL","30","Select","Select",""],["","27241009706","DULOXETINE ","CAP 20MG","30","Select","Select",""],["","29300013601","CLONIDINE ","TAB 0.2MG","30","Select","Select",""],["","51224012230","AZITHROMYCIN ","TAB 500MG","5","Select","Select",""],["","53746051101","SPIRONOLACT ","TAB 25MG","90","Select","Select",""],["","64380080807","IBUPROFEN ","TAB 600MG","90","Select","Select",""],["","00054001925","PREDNISONE ","TAB 50MG","5","Select","Select",""],["","00093317431","ALBUTEROL ","AER HFA","8","Select","Select",""],["","68462010530","ONDANSETRON ","TAB 4MG","18","Select","Select",""],["","08373982700","OPTICHAMBER ","MIS DIA LG","1","Select","Select",""],["","59310057922","PROAIR ","AER ","8","Select","Select",""],["","63402030230","LATUDA ","TAB 20MG","5","Select","Select",""],["","33332032001","AFLURIA ","INJ 2020-21","0","Select","Select",""],["","64764073030","TRINTELLIX ","TAB 10MG","30","Select","Select",""],["","68462013701","OXCARBAZEPIN ","TAB 150MG","60","Select","Select",""],["","59267100001","PFIZER ","INJ COVID-19","0","Select","Select",""],["","69452015120","VITAMIN ","CAP 50000UNT","12","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":""}]}]}