{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIFFANY MCGUIRE","gend":1,"add":"8203 BULL HILL ROAD","city":"PRINCE GEORGE","state":"VA","zip":"23875-9998","dob":"1994-06-16","age":"","mstatus":"","insh":"1765568*01","cliId":"","pno":"804\/929-1950","cno":"","email":"","ename":"","eno":"","pphy":"MADRID MALO BOHORQUEZ, VALERIA MD","ppno":"804\/526-8640","pcpadd":"50 MEDICAL PARK BLVD SUITE C","pcpcity":"PETERSBURG","pcpstate":"VA","pcpzip":23805,"pcpcounty":"","pcpid":"","pcpname":"SOUTHSIDE PHYSICIANS NETWORK - INTERNAL MEDICINE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/526-4321","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z31.69","E28.2","L91.0","L29.8","R20.8","Z20.828","D22.4","Z01.419","Z68.42","S99.921A","R30.0","N92.0","L85.8","L85.3","L20.84","L53.8","S92.534A","E11.9","E66.01","E03.9","R73.03","L24.9","I10.","Z79.84","J30.9","Z79.899","R51.9","J45.909","K21.9","E66.9","R11.0","I49.8"],"date":["2019-02-25","2022-07-06","2022-09-13","2022-04-05","2019-12-27","2021-09-04","2020-05-15","2020-02-18","2022-10-26","2021-01-08","2021-09-14","2021-09-14","2022-09-13","2021-11-30","2021-11-30","2021-11-30","2021-01-12","2022-10-12","2022-10-12","2022-10-26","2022-01-12","2022-01-31","2022-10-12","2022-07-06","2022-07-06","2022-07-06","2022-10-26","2022-10-26","2022-10-26","2022-10-26","2022-10-26","2022-10-26"],"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":[["","67877056105","METFORMIN","TAB 500MG","360","Select","Select",""],["","53885000810","ONETOUCH","MIS PLUS 33G","100","Select","Select",""],["","69238183107","LEVOTHYROXIN","TAB 50MCG","90","Select","Select",""],["","11917004918","ACETAMIN","TAB 500MG","21","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00065815001","PATADAY","SOL 0.002","2","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","10","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","00904598463","AMMONIUM","LOT 0.12","396","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","2","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","68682010810","NIFEDIPINE","TAB 30MG ER","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","5","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","59762005601","MEDROXYPR","TAB 10MG","10","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":""}]}]}