{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHANIE   A STEVENS","gend":1,"add":"51 OLD AIRPORT RD","city":"LANCASTER","state":"VA","zip":"22503-9998","dob":"1989-11-21","age":"","mstatus":"","insh":"20053556*01","cliId":"","pno":"804\/436-4351","cno":"804\/436-4351","email":"","ename":"","eno":"","pphy":"CORSA, ERIN NP","ppno":"804\/462-5155","pcpadd":"36 LIVELY OAKS ROAD","pcpcity":"LIVELY","pcpstate":"VA","pcpzip":22507,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS LIVELY MEDICAL CENTER","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/462-5922","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z01.419","N60.12","Z30.40","F41.9","F90.9","F63.3","Z30.42","M21.6X2","M21.6X1","S90.02XS","S99.912A","M25.373","M25.572","M79.7","Z20.828","J06.9","R05.1","Z87.891","M25.372","M79.609","R26.2","R60.0","R11.2","Z20.822","F39.","F90.2","L01.00","K14.0","Z68.36","Z82.49","Z80.41","E66.9","D68.4","J40.","Z01.411","Z11.3","Z32.02","B37.3","N90.89","Z83.2","F42.2","Z68.37","M25.473","R35.0","N12.","Z11.1","R87.612","J01.90","M65.9","Z68.38","Z79.899","R07.89","M54.12","F17.200","F32.9","R73.01","R63.5","Z23.","Z13.6","Z71.6"],"date":["2020-07-13","2020-07-13","2021-07-26","2022-10-12","2022-10-12","2022-10-12","2022-09-28","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-07-26","2021-01-04","2022-09-27","2021-01-27","2022-09-22","2022-09-22","2022-09-27","2020-07-06","2020-10-12","2021-07-26","2020-07-06","2020-09-30","2021-01-03","2021-02-01","2021-02-01","2021-07-23","2021-07-23","2021-07-23","2022-09-22","2022-02-25","2022-02-25","2022-02-25","2022-09-27","2022-09-28","2022-09-28","2022-11-01","2021-04-26","2021-04-26","2021-10-19","2021-10-19","2021-10-19","2020-06-05","2022-03-04","2022-03-04","2022-04-18","2022-11-01","2020-01-31","2020-06-23","2021-10-28","2022-09-22","2022-09-22","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-03-03","2020-09-15"],"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":[["","43598081115","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","60","Select","Select",""],["","00228202796","ALPRAZOLAM","TAB 0.25MG","14","Select","Select",""],["","50111064701","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","43547029010","BUPROPION","TAB 200MG SR","30","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00555097202","AMPHET\/DEXTR","TAB 10MG","90","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","45802006405","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","59762453802","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","45963055550","GABAPENTIN","CAP 100MG","270","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","180","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","30","Select","Select",""],["","43598029590","PREGABALIN","CAP 150MG","60","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","00378623101","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","51224012230","AZITHROMYCIN","TAB 500MG","5","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68382024705","BENZONATATE","CAP 100MG","40","Select","Select",""],["","00069046956","CHANTIX","TAB 1MG","60","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","00135019402","NICODERM","DIS 21MG\/24H","28","Select","Select",""],["","00591505210","PREDNISONE","TAB 5MG","20","Select","Select",""],["","31722071030","SILDENAFIL","TAB 50MG","2","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","14","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","51267089099","CONTRAVE","TAB 8-90MG","21","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":""}]}]}