{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HOLLY   V ODOM","gend":1,"add":"4730 DONELSON RD APT 14","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1982-07-21","age":"","mstatus":"","insh":"1931170*01","cliId":"","pno":"757\/580-5296","cno":"","email":"","ename":"","eno":"","pphy":"AMABILE, ANTHONY T MD","ppno":"757\/464-2013","pcpadd":"816 INDEPENDENCE #G","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":"","pcpname":"Bayside\/Amabile","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/464-3046","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","F43.21","K51.90","F41.9","F98.8","E53.8","R73.01","B08.4","S62.101A","S62.102A","S63.601A","L02.214","L98.8","Z87.19","Z01.419","F32.9","Z00.00","D50.8","L02.91","S52.501A","S52.502A","Z11.3","N94.3","N90.89","E55.9","L73.2","R19.7","R19.4","R12.","D12.0","S52.571A","S52.572A","K63.5","K64.8","K92.1","R10.9","K59.00","K21.9"],"date":["2020-10-29","2020-10-29","2022-05-27","2022-05-27","2022-05-27","2022-05-27","2022-05-27","2020-04-30","2020-05-26","2020-05-26","2020-08-11","2022-03-14","2022-06-23","2022-01-20","2021-09-24","2021-05-18","2021-12-13","2022-03-14","2022-05-27","2020-05-26","2020-05-26","2021-09-24","2021-09-24","2021-09-24","2022-03-14","2022-08-11","2020-10-12","2022-10-25","2020-09-29","2020-10-12","2020-05-28","2020-05-28","2020-10-12","2020-10-12","2022-10-25","2022-10-25","2022-10-25","2022-10-25"],"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":[["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00093100301","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00378113401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","90","Select","Select",""],["","51672131201","MUPIROCIN","OIN 0.02","45","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","65862001230","SERTRALINE","TAB 50MG","135","Select","Select",""],["","00228202996","ALPRAZOLAM","TAB 0.5MG","20","Select","Select",""],["","00143993905","AMOXICILLIN","CAP 500MG","4","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":""}]}]}