{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBECCA HENSLEY","gend":1,"add":"191 SUNDANCE MOUNTAIN ROAD CHUCK MERICA","city":"NEW MARKET","state":"VA","zip":"22844-9998","dob":"1971-04-01","age":"","mstatus":"","insh":"20029058*01","cliId":"","pno":"540\/830-0480","cno":"","email":"","ename":"","eno":"","pphy":"MAZER, TRENT W MD","ppno":"540\/564-5666","pcpadd":"Sentara Timber Way Health Center 13","pcpcity":"BROADWAY","pcpstate":"VA","pcpzip":22815,"pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara Timber Way Health Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/579-8594","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.65","H53.8","R42.","M54.5","R63.5","D64.9","NO DATA","G89.29","Z87.828","E66.01","Z68.43","F31.74","R51.","J45.40","M79.675","B35.1","L60.0","K29.70","M79.671","E11.9","L60.3","T73.3XXA","F31.71","E78.5","R73.9","Z79.899","J30.89","R11.0","R51.9","E66.09","S99.922A","M79.672","E16.1","E16.2","R40.4","R41.82","R09.02","Z23.","K29.50"],"date":["2021-11-12","2019-05-28","2021-11-12","2021-02-23","2019-05-28","2019-05-28","2021-11-12","2021-11-12","2020-08-10","2020-06-29","2019-12-02","2019-12-02","2020-06-29","2021-11-12","2021-02-22","2021-02-22","2021-02-22","2021-02-23","2021-01-29","2021-01-29","2021-01-29","2021-06-22","2021-11-12","2021-11-12","2019-02-21","2021-02-23","2021-11-12","2021-02-23","2021-11-12","2021-02-23","2020-10-15","2020-10-19","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-11-12","2021-11-12"],"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":[["","66993006885","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00085461005","DULERA","AER 200-5MCG","18","Select","Select",""],["","29300011516","TOPIRAMATE","TAB 25MG","120","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","60505257809","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","57237001990","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","","ONDANSETRON","TAB 4MG ODT","","Select","Select",""],["","55111072530","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","16729014912","QUETIAPINE","TAB 300MG","60","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","30","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","14","Select","Select",""],["","","MECLIZINE","TAB 25MG","","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","59676058015","JANSSEN","INJ COVID-19","0","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","","EPINEPHRINE","INJ 0.3MG","","Select","Select",""],["","","SSD","CRE 0.01","","Select","Select",""],["","","FLUZONE","INJ 2020-21","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","60","Select","Select",""],["","16729002010","PIOGLITAZONE","TAB 15MG","30","Select","Select",""],["","00536110788","NICOTINE","DIS 14MG\/24H","14","Select","Select",""],["","08317782001","RELION","MIS MONITOR","1","Select","Select",""],["","00069046856","CHANTIX","TAB 0.5MG","60","Select","Select",""],["","00093221005","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","49035019502","EQ","DIS 14MG\/24H","28","Select","Select",""],["","58914017014","CARAFATE","SUS 1GM\/10ML","1200","Select","Select",""],["","33332041910","AFLURIA","INJ 2019-20","0","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}