{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AUTUMN   D SALYERS","gend":1,"add":"374 NORFOLK AVE","city":"BRISTOL","state":"VA","zip":"24201-9998","dob":"2004-01-13","age":"","mstatus":"","insh":"1581901*01","cliId":"","pno":"276\/644-1976","cno":"","email":"","ename":"","eno":"","pphy":"MCCLINTIC, ANDREA DO","ppno":"276\/669-5179","pcpadd":"2195 EUCLID AVE SUITE 6","pcpcity":"BRISTOL","pcpstate":"VA","pcpzip":24201,"pcpcounty":"","pcpid":"","pcpname":"SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/466-8870","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.9","F41.1","Z23.","Z91.5","M25.561","R10.811","R10.816","K21.9","R11.2","R39.9","S90.32XA","S99.922A","L02.414","L73.9","N39.0","R11.0","L98.9","R00.0","R19.7","R20.0","R11.10","R55.","R42.","R82.5","J06.9","R05.9","N92.0","R10.13","J30.2","E55.9","Z30.09","Z11.59","J01.00","R10.84","R31.9","R10.31"],"date":["2021-08-13","2021-08-13","2021-08-16","2021-07-23","2020-01-02","2021-04-10","2021-04-10","2022-10-21","2022-11-03","2021-03-19","2020-07-08","2020-07-08","2020-02-10","2020-11-30","2022-09-14","2021-03-09","2021-03-09","2021-03-29","2021-03-29","2021-05-02","2021-05-02","2021-05-02","2021-05-02","2021-05-02","2021-11-06","2021-11-06","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-11-03","2022-09-27","2022-08-27","2022-08-27","2022-11-03"],"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":[["","00781261301","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","65162035803","ZAFEMY","DIS 150\/35","3","Select","Select",""],["","00378334053","XULANE","DIS 150-35","3","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","29033000301","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","57237007730","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","","SMZ\/TMP","TAB 800-160","","Select","Select",""],["","59746017206","PREDNISONE","TAB 5MG","10","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","","NITROFURANTN","CAP 100MG","","Select","Select",""],["","50228011401","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","","HYDROXYZ","TAB 25MG","","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","65162071110","GUANFACINE","TAB 1MG","45","Select","Select",""],["","57237023301","SMZ-TMP","TAB 800-160","14","Select","Select",""],["","16714047802","AMOX\/K","TAB 875-125","14","Select","Select",""],["","58657067601","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","","QUETIAPINE","TAB 50MG","","Select","Select",""],["","","CLINDAMYCIN","CAP 300MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","57237000830","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","","TRAZODONE","TAB 100MG","","Select","Select",""],["","00406048401","APAP\/CODEINE","TAB 300-30MG","12","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":""}]}]}