{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARRIE UPSHUR","gend":1,"add":"3090 NEW LONDON ROAD","city":"FOREST","state":"VA","zip":"24551-9998","dob":"1975-10-30","age":"","mstatus":"","insh":"1554673*01","cliId":"","pno":"434\/473-1337","cno":"434\/473-1337","email":"","ename":"","eno":"","pphy":"HOATH, MARCY K PA","ppno":"434\/200-3366","pcpadd":"800 5TH STREET","pcpcity":"LYNCHBURG","pcpstate":"VA","pcpzip":24504,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/847-2521","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.89","N30.01","R30.9","N93.9","F90.1","R10.2","F17.210","Z00.00","Z87.42","N92.1","N92.0","Z30.430","M54.9","R10.9","Z87.440","M54.5","M54.31","M51.36","M25.561","R35.0","R10.11","R93.2","Z72.0","R03.0","E78.2","R73.09","Z86.59","R11.2","F12.90","Z13.6","Z11.4","Z11.59","Z13.1","Z13.220","D64.9","R11.10","N92.6","M05.40","T07.XXXA","F31.9","I10.","R20.2","Z13.29","M25.50","D36.7","M79.601","M85.631"],"date":["2021-05-13","2021-10-15","2021-10-15","2022-11-08","2022-04-18","2020-12-01","2022-11-01","2021-05-05","2021-05-05","2022-04-05","2021-05-05","2021-05-05","2021-11-05","2021-11-09","2021-11-08","2020-01-20","2020-01-20","2020-01-20","2020-01-20","2021-06-07","2021-11-08","2021-11-08","2021-11-08","2020-07-15","2020-07-15","2022-11-08","2020-07-15","2022-01-06","2022-01-06","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2022-11-08","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2021-04-05","2021-09-15","2022-11-08","2022-11-08","2022-11-08","2022-11-08","2022-11-01","2022-11-01","2022-11-01"],"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":[]},{"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":[["","57237016199","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00904631256","COUGH","SUS 30MG\/5ML","89","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00228306011","AMPHET\/DEXTR","CAP 20MG ER","30","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","5","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","60","Select","Select",""],["","43547034206","RISPERIDONE","TAB 2MG","30","Select","Select",""],["","59267102504","PFIZER","INJ ADLT RTU","0","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","28","Select","Select",""],["","16729004517","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","57237023305","SMZ-TMP","TAB 800-160","20","Select","Select",""],["","43547035311","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","63824017563","DELSYM","SUS 30MG\/5ML","89","Select","Select",""],["","59762500801","MISOPROSTOL","TAB 200MCG","2","Select","Select",""],["","00574200830","NYSTOP","POW 100000","30","Select","Select",""],["","00363106108","ANTISEPTIC","SOL SKIN CLN","237","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","55111012705","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","14","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","14","Select","Select",""],["","54092038701","ADDERALL","CAP 20MG","30","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","5","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00527133010","BACLOFEN","TAB 10MG","30","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}