{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUSIE   A STEPHENS","gend":1,"add":"739 BRICKYARD ROAD","city":"EMPORIA","state":"VA","zip":"23847-9998","dob":"1961-04-12","age":"","mstatus":"","insh":"20007592*01","cliId":"","pno":"434\/378-5514","cno":"","email":"","ename":"","eno":"","pphy":"ANDERSON, MICHAEL S MD","ppno":"434\/634-6101","pcpadd":"6 DOCTORS DRIVE","pcpcity":"EMPORIA","pcpstate":"VA","pcpzip":23847,"pcpcounty":"","pcpid":"","pcpname":"EMPORIA MEDICAL ASSOCIATES PC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/634-7107","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z45.02","I42.9","T82.190A","I11.0","I50.22","R60.9","R06.02","I50.9","J44.9","R59.0","R06.00","I50.23","R79.89","F17.210","I51.7","J44.1","F12.10","I10.","M06.9","Z72.0","Z95.810","L29.9","T78.1XXA","I08.3","Z20.822","I25.5","K21.9","T82.110A","I51.9","I25.10","F41.9","N39.0","I25.2","Z79.82","Z79.51","Z79.899","Z95.5","Z28.09","R07.89"],"date":["2020-02-07","2022-04-11","2020-02-27","2022-10-29","2022-04-11","2022-02-08","2022-02-08","2022-10-29","2022-02-09","2022-02-11","2022-02-09","2022-02-11","2022-02-11","2022-04-11","2020-02-27","2022-02-11","2022-02-08","2022-02-08","2022-02-08","2022-02-11","2022-02-11","2022-07-11","2022-07-11","2022-02-08","2022-02-11","2022-10-29","2022-02-11","2020-02-27","2022-02-07","2022-02-07","2020-05-29","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-10-29"],"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":[["","00143177201","ISOSORB","TAB 20MG","60","Select","Select",""],["","59746021601","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","90","Select","Select",""],["","65862014305","CARVEDILOL","TAB 6.25MG","60","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","43547035410","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","9","Select","Select",""],["","60258017101","MAG","TAB 400MG","60","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","60","Select","Select",""],["","00904675180","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","49348098023","SM","TAB 81MG EC","30","Select","Select",""],["","65862053650","LEVOFLOXACIN","TAB 250MG","7","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","64376064801","HYDROCO\/APAP","TAB 5-300MG","5","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","7","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","480","Select","Select",""],["","68462018022","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","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":[]}},{"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":""}]}]}