{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EMILY   B PEARCE","gend":1,"add":"301 DINWIDDIE AVE","city":"BLACKSTONE","state":"VA","zip":"23824-9998","dob":"1968-07-02","age":"","mstatus":"","insh":"20064864*01","cliId":"","pno":"434\/294-2187","cno":"434\/294-2187","email":"","ename":"","eno":"","pphy":"EGGLESTON III, WILLIAM MD","ppno":"434\/292-7261","pcpadd":"213 NORTH MAIN ST","pcpcity":"BLACKSTONE","pcpstate":"VA","pcpzip":23824,"pcpcounty":"","pcpid":"","pcpname":"BLACKSTONE FAMILY PRACTICE CENTER","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/292-7965","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.0","R06.02","Z09.","R53.82","R06.83","L60.0","S39.012A","Z12.31","F25.0","R73.03","G47.33","J20.9","R68.89","F31.9","D72.829","D75.1","R93.89","R06.2","Z72.0","Z92.89","R06.00","E66.01","Z20.822","J44.9","Z68.41","M25.511","M25.551","M25.552","M50.30","F17.210","Z79.899","W01.0XXA","Y92.89","J06.9","Z12.39","R06.81","M76.62","B35.1","S91.301A","L03.111","M54.5","G89.29","J01.10","F51.01","J34.89","J98.11","K76.0","E27.9","M72.2","M79.674","M79.672","M79.601","J44.0","F33.9","Z68.37","B34.9","Z20.828","E86.0","R50.9","Z79.01","Z88.8","J40."],"date":["2020-10-07","2020-10-07","2020-10-07","2020-10-07","2021-03-24","2021-04-26","2021-08-09","2021-03-23","2022-09-16","2022-09-16","2021-08-24","2020-10-04","2020-10-06","2020-10-06","2020-10-06","2020-10-04","2021-06-16","2020-10-06","2021-06-16","2020-11-13","2021-03-03","2021-08-25","2021-01-08","2021-08-25","2021-08-31","2021-08-31","2021-08-31","2021-08-31","2021-08-25","2022-02-15","2021-08-25","2021-08-25","2021-08-25","2020-03-03","2020-03-03","2021-06-16","2021-05-17","2021-05-17","2021-05-17","2021-08-09","2021-08-09","2021-08-09","2020-12-04","2022-09-16","2021-03-24","2021-03-03","2021-03-03","2021-03-03","2021-04-26","2021-04-26","2021-04-26","2021-08-25","2022-02-15","2022-09-16","2022-09-16","2020-06-12","2020-10-04","2020-10-04","2020-10-04","2020-10-04","2020-10-04","2020-12-10"],"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":[["","59310057922","PROAIR","AER ","8","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","68001018100","QUETIAPINE","TAB 400MG","90","Select","Select",""],["","68001036206","CEFDINIR","CAP 300MG","10","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","00904698640","MUCUS","TAB 600MG ER","60","Select","Select",""],["","68001028000","DICLOFENAC","TAB 50MG DR","60","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","68382070718","DOXYCYC","CAP 100MG","10","Select","Select",""],["","42858011830","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","49281040020","ADACEL","INJ ","0","Select","Select",""],["","63481068447","VOLTAREN","GEL 0.01","100","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","14","Select","Select",""],["","69452014330","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00603533932","PREDNISONE","TAB 20MG","5","Select","Select",""],["","00536589653","NICOTINE","DIS 21MG\/24H","21","Select","Select",""],["","37000014343","ALIGN","CAP 4MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","46122041660","GNP","TAB 600MG","60","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":""}]}]}