{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"FABIAN FOWLER","gend":0,"add":"1929 THAXTON SCHOOL RD APT B","city":"THAXTON","state":"VA","zip":"24174-9998","dob":"1993-09-20","age":"","mstatus":"","insh":"20051287*01","cliId":"","pno":"540\/816-3810","cno":"540\/816-3810","email":"","ename":"","eno":"","pphy":"MINOTTI, CRISTINA MARIA FNP","ppno":"434\/528-0005","pcpadd":"925 VILLAGE HWY","pcpcity":"RUSTBURG","pcpstate":"VA","pcpzip":24588,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/528-0004","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F43.10","F20.9","F33.1","H65.92","I10.","F90.9","F51.01","B02.8","K29.80","K20.8","K44.9","R11.2","K31.7","K21.9","R10.13","Z71.9","Z28.21","F32.1","F25.1","R17.","NO DATA","N17.9","E86.0","B02.9","F90.2","R52.","R11.10","F41.9","Z20.828","Z79.51","Z79.899","Z82.49","Z83.3","Z88.2","F17.200","K31.89","K21.0","H66.005","Z91.09","J32.9","H92.03","R36.9","R39.198","F17.290","N64.59","R65.10","E87.1","J45.909","F31.9","F12.90","F17.210","K22.8","J38.5","J45.30","R19.7","M79.672","M79.671","R39.11","Z71.3","H93.13","H91.93","H92.02","R07.0","R39.15"],"date":["2021-12-07","2021-12-07","2021-12-07","2020-07-31","2021-09-20","2021-12-07","2021-09-20","2020-07-31","2020-08-17","2020-08-17","2020-09-28","2020-09-28","2020-08-17","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2021-12-05","2021-07-28","2022-01-14","2022-01-14","2020-08-06","2020-08-05","2020-08-06","2020-08-05","2020-12-13","2020-12-13","2020-12-13","2020-12-13","2020-12-13","2020-12-13","2020-12-13","2020-12-13","2020-12-13","2021-09-20","2020-08-06","2020-09-24","2020-08-27","2021-04-22","2022-06-22","2022-06-22","2020-01-22","2020-01-22","2020-05-21","2020-05-21","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2020-08-05","2021-02-19","2021-02-19","2021-02-19","2021-02-19","2020-09-02","2020-11-19","2020-09-08","2020-09-08","2020-09-08","2022-06-22","2020-07-10"],"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":[["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","29033000305","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","43598075205","BUPROPION","TAB 150MG SR","180","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","68645014059","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","60505283503","ATOMOXETINE","CAP 80MG","30","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","49035061344","EQ","GUM 4MG MINT","100","Select","Select",""],["","68645055854","LISINOP\/HCTZ","TAB 20-25MG","90","Select","Select",""],["","70954002120","PRAZOSIN","CAP 5MG","90","Select","Select",""],["","00185061505","HYDROXYZ","CAP 50MG","360","Select","Select",""],["","16729017217","AMITRIPTYLIN","TAB 25MG","30","Select","Select",""],["","00536338601","NICOTINE","GUM 2MGFRUIT","100","Select","Select",""],["","00904131546","BISMATROL","CHW 262MG","240","Select","Select",""],["","58914017014","CARAFATE","SUS 1GM\/10ML","1200","Select","Select",""],["","33342020010","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","30","Select","Select",""],["","37000014343","ALIGN","CAP 4MG","28","Select","Select",""],["","49100040009","CULTURELLE","CAP ","30","Select","Select",""],["","00002325130","STRATTERA","CAP 100MG","30","Select","Select",""],["","00228143503","LAMOTRIGINE","TAB 50MG ER","30","Select","Select",""],["","33342012407","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","00904645780","DOK","CAP 100MG","20","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","10","Select","Select",""],["","65702071910","ACCU-CHEK","TES GUIDE","100","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","66993068330","OLANZAPINE","TAB 10MG","30","Select","Select",""],["","49035030890","PAIN","TAB 500MG","240","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","60505024701","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","69097012315","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","65862044930","VALACYCLOVIR","TAB 1GM","14","Select","Select",""],["","62332002331","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","37000047709","PEPTO-BISMOL","CHW 262MG","240","Select","Select",""],["","49035012249","PINK","CHW 262MG","240","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":""}]}]}