{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA MATLAND","gend":1,"add":"1177 SHEPHERDS RIDGE LN","city":"THAXTON","state":"VA","zip":"24174-9998","dob":"1982-08-21","age":"","mstatus":"","insh":"2079014*01","cliId":"","pno":"540\/816-9157","cno":"","email":"","ename":"","eno":"","pphy":"STAUFFER, JASMINE PA","ppno":"540\/425-7910","pcpadd":"582 BLUE RIDGE AVE","pcpcity":"BEDFORD","pcpstate":"VA","pcpzip":"24523","pcpcounty":"","pcpid":"","pcpname":"JOHNSON HEALTH CENTER","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/583-5149","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O80.","Z3A.00","Z37.0","F43.12","F33.1","F43.22","Z62.811","F41.9","E03.9","F51.8","E55.9","K04.7","I10.","O99.824","O99.344","Z87.891","Z3A.39","O69.81X0","Z34.83","Z39.2","Z30.431","F43.10","F41.1","Z63.4","F40.01","F33.9","G47.00","F12.90","Z30.430","R50.9","J06.9","R52.","R05.","R53.83"],"date":["2020-01-06","2020-01-06","2020-01-06","2020-12-18","2021-09-21","2020-12-18","2020-12-18","2021-09-21","2021-09-21","2021-09-03","2021-03-25","2021-12-30","2021-12-30","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-01-06","2020-02-18","2020-12-21","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2021-11-05","2020-03-04","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2020-11-02"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","59148003713","REXULTI","TAB 1MG","30","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","120","Select","Select",""],["","43547030303","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","00456114030","VIIBRYD","TAB 40MG","60","Select","Select",""],["","00228142203","LAMOTRIGINE","TAB 100MG ER","30","Select","Select",""],["","65757050003","ARISTADA","INJ INITIO","2","Select","Select",""],["","00378180010","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","50428029464","CVS","TAB 8.6-50MG","60","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00591555501","PROPRANOLOL","TAB 20MG","180","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","00093226401","AMOXICILLIN","TAB 875MG","24","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","90","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":""}]}]}