{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JENNIFER MCAULEY","gend":1,"add":"2930 PERDUE AVE","city":"CHESTER","state":"VA","zip":"23831-9998","dob":"1983-06-09","age":"","mstatus":"","insh":"1056472*01","cliId":"","pno":"804\/519-0155","cno":"","email":"","ename":"","eno":"","pphy":"ROSE, ANDREW MD","ppno":"804\/717-5300","pcpadd":"SUITE 117 16011 IRONBRIDGE ROAD","pcpcity":"CHESTER","pcpstate":"VA","pcpzip":23831,"pcpcounty":"","pcpid":"","pcpname":"IRONBRIDGE FAMILY PRACTICE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/748-7269","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.709","F32.0","F41.9","Z68.41","N92.0","N94.6","Z68.42","S93.402A","R10.2","N70.11","H66.002","Z01.419","F32.9","E66.9","R07.2","N83.8","N70.92","N94.89","J10.1","D06.9","K62.5","D06.0","J20.9","R05.","R87.610","R87.810"],"date":["2021-04-06","2021-04-06","2021-04-06","2020-09-24","2021-07-13","2021-07-13","2021-04-06","2021-04-17","2020-03-02","2020-03-10","2020-11-22","2021-05-27","2021-05-27","2021-06-23","2020-07-24","2020-03-10","2020-03-10","2020-03-10","2020-01-30","2019-09-06","2019-11-06","2019-02-12","2019-04-29","2019-04-29","2019-01-08","2019-01-08"],"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":[["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","68462030205","INDOMETHACIN","CAP 50MG","20","Select","Select",""],["","","PROPRANOLOL","CAP 80MG ER","","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","","NAPROXEN"," NAPROXEN ","20","Select","Select",""],["","","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","58160084252","BOOSTRIX","INJ ","0","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","TRANEX"," TRANEX ","18","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","8","Select","Select",""],["","","METHYLPRED"," METHYLPRED ","21","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","","BENZONATATE"," BENZONATATE ","15","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","","LEVOFLOXACIN","TAB 500MG","","Select","Select",""],["","","FLUOXETINE","CAP 20MG","","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":""}]}]}