{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALICIA   M WATERS","gend":1,"add":"471 MT CARMEL ROAD","city":"LURAY","state":"VA","zip":"22835-9998","dob":"1977-01-02","age":"","mstatus":"","insh":"1119202*01","cliId":"","pno":"540\/244-7728","cno":"","email":"","ename":"","eno":"","pphy":"DALE, JAMES G DO","ppno":"540\/743-2887","pcpadd":"135 MEMORIAL DRIVE","pcpcity":"LURAY","pcpstate":"VA","pcpzip":22835,"pcpcounty":"","pcpid":"","pcpname":"PAGE MEMORIAL HOSPITAL INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/743-1288","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S83.511A","V58.89","Z47.89","NO DATA","G47.33","I38.","S20.469A","W57.XXXA","Z20.822","I34.0","J01.11","R05.","R50.9","J34.89","R09.81","R53.83","R26.2","M25.561","M62.81","R26.89","M23.611","Z23.","U07.1","A69.20","E66.09","G56.91","Z20.828","J02.9","G89.18","M23.8X1","G89.29","J06.9","Z95.3","M54.9","R51.","R20.2","R11.2","R10.11","R19.4","R74.8","K22.8","M54.6","M54.5","M19.90","M10.9","I05.9","B96.89","M23.91","X50.1XXA","Y93.01","Z01.810"],"date":["2020-04-15","2020-02-18","2020-06-12","2021-09-07","2020-11-04","2020-11-04","2020-05-04","2020-05-04","2021-10-18","2021-12-17","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2020-04-15","2020-04-15","2020-04-15","2020-04-15","2020-04-15","2021-12-17","2021-10-22","2020-05-08","2020-11-04","2020-11-04","2021-09-07","2021-09-07","2020-02-07","2019-10-28","2019-10-28","2019-11-05","2019-04-22","2019-06-04","2019-10-04","2019-10-04","2019-10-04","2019-03-12","2019-02-27","2019-03-12","2019-03-12","2019-06-04","2019-06-04","2019-12-28","2019-12-28","2019-05-01","2019-11-05","2019-09-04","2019-09-04","2019-09-04","2019-11-12"],"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":[["","69097012403","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","70436001102","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","00832054111","BUMETANIDE","TAB 1MG","60","Select","Select",""],["","00245531711","KLOR-CON","TAB 10MEQ ER","60","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","57664050658","METOPROL","TAB 25MG","60","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","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":""}]}]}