{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRACY FERGUSON","gend":1,"add":"7601 MAIN ST APT F8","city":"MIDDLETOWN","state":"VA","zip":"22645-9998","dob":"1975-12-11","age":"","mstatus":"","insh":"20063151*01","cliId":"","pno":"540\/331-8840","cno":"540\/331-8840","email":"","ename":"","eno":"","pphy":"DRESSLER, WILLIAM C MD","ppno":"540\/465-3751","pcpadd":"33674 OLD VALLEY PIKE","pcpcity":"STRASBURG","pcpstate":"VA","pcpzip":22657,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN\/ WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/465-5008","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","I10.","F17.200","J45.909","Z95.810","Z20.822","R51.9","Z71.89","F31.9","F11.20","R11.2","R05."],"date":["2020-11-03","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2021-01-18","2021-01-08","2021-01-08","2021-07-27","2022-09-30","2021-01-18","2021-01-18"],"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":[["","12496120803","SUBOXONE","MIS 8-2MG","9","Select","Select",""],["","00054018913","BUPREN\/NALOX","SUB 8-2MG","2","Select","Select",""],["","00093216568","NALOXONE","SPR 4MG","2","Select","Select",""],["","00597002402","COMBIVENT","AER 20-100","4","Select","Select",""],["","29300011201","LAMOTRIGINE","TAB 100MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","43547028111","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","29300046801","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","11877001140","BINAXNOW","KIT HOME TES","2","Select","Select",""],["","00093083201","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","67877019705","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00185061501","HYDROXYZ","CAP 50MG","60","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","27","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00406117003","NALTREXONE","TAB 50MG","30","Select","Select",""],["","68001018408","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","28","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","6","Select","Select",""],["","66993068330","OLANZAPINE","TAB 10MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","4","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":""}]}]}