{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA  K STEBBINS","gend":1,"add":"603 W SECOND ST","city":"CHASE CITY","state":"VA","zip":23924,"dob":"1969-03-15","age":"","mstatus":"","insh":"20035563*01","cliId":"","pno":"434\/755-3132","cno":"434\/755-3132","email":"","ename":"","eno":"","pphy":"MILAM, ALYSSA NP","ppno":"434\/372-5141","pcpadd":"946 N MAIN ST","pcpcity":"CHASE CITY","pcpstate":"VA","pcpzip":23924,"pcpcounty":"","pcpid":"","pcpname":"DOMINION HEALTH MEDICAL ASSOCIATES LTD","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/372-8910","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.46","E11.69","Z23.","E78.2","F31.76","K58.8","K21.9","M54.5","L30.9","G89.29","L02.91","M75.82","F31.78","B37.89","M17.11","J06.9","R50.9","M25.561","M25.461","M25.571","R21."],"date":["2021-12-02","2021-10-20","2021-10-20","2021-10-20","2021-12-02","2021-10-20","2020-06-04","2021-09-02","2020-06-04","2020-06-04","2021-05-26","2020-07-20","2019-05-07","2019-05-07","2019-05-07","2019-04-08","2019-04-08","2019-02-05","2019-02-05","2019-02-05","2019-12-09"],"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":[["","00591079410","DICYCLOMINE","CAP 10MG","90","Select","Select",""],["","16729004517","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00591401201","VALPROIC","CAP 250MG","60","Select","Select",""],["","00472037945","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","10","Select","Select",""],["","24689090701","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","56151146304","TRUE","TES GLUCOSE","50","Select","Select",""],["","08484073200","PRODIGY","TES CODING","50","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","51224000760","METFORMIN","TAB 500MG ER","60","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","60432060616","PROMETH\/COD","SOL 6.25-10","120","Select","Select",""],["","69315030615","NYSTATIN","POW 100000","15","Select","Select",""],["","45802043411","CLOTRIMAZOLE","CRE 0.01","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":""}]}]}