{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEAH HUDDLESTON","gend":1,"add":"PO BOX 948","city":"GLOUCESTER","state":"VA","zip":"23061-9998","dob":"1976-01-27","age":"","mstatus":"","insh":"20060500*01","cliId":"","pno":"804\/694-0989","cno":"804\/694-0989","email":"","ename":"","eno":"","pphy":"WEST III, FRANCIS T MD","ppno":"804\/684-5043","pcpadd":"6530 MAIN ST","pcpcity":"GLOUCESTER","pcpstate":"VA","pcpzip":23061,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/684-5392","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E03.9","R63.5","K70.30","L30.9","B07.9","Z20.828","Z20.822","Z68.30","K26.9","Z98.84","M79.643","G56.01","R22.32","F43.22","K95.09","R18.8","I87.1","I82.C11","M79.631","S93.432A","M79.641","R59.0"],"date":["2020-10-26","2020-03-06","2020-08-03","2020-03-06","2020-06-23","2021-11-07","2022-01-10","2020-08-03","2020-10-26","2020-10-26","2021-02-19","2021-09-02","2020-06-30","2020-09-21","2020-10-26","2020-10-26","2020-10-26","2020-10-26","2021-02-03","2021-12-16","2021-03-09","2020-06-23"],"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":[["","21922002107","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","53746051501","SPIRONOLACT","TAB 100MG","180","Select","Select",""],["","69238183801","LEVOTHYROXIN","TAB 150MCG","90","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","180","Select","Select",""],["","42799011101","ETODOLAC","TAB 400MG","63","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","12","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","51672403201","WARFARIN","TAB 5MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68382032001","POT  CHLORIDE","TAB 10MEQ ER","120","Select","Select",""],["","00536354701","DAILY-VITE","TAB ","30","Select","Select",""],["","00904053060","TAB-A-VITE","TAB ","30","Select","Select",""],["","66689000816","NYSTATIN","SUS 100000","120","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","28","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","20","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":""}]}]}