{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AALIYAH   I MARSHALL","gend":1,"add":"406 LAUREL ST APT 2","city":"CULPEPER","state":"VA","zip":"22701-9998","dob":"2003-05-06","age":"","mstatus":"","insh":"2122132*01","cliId":"","pno":"540\/423-8376","cno":"540\/423-8376","email":"","ename":"","eno":"","pphy":"CORBIN, CONSTANCE NP","ppno":"540\/321-3002","pcpadd":"633 Sunset Ln Ste A","pcpcity":"CULPEPER","pcpstate":"VA","pcpzip":22701,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/829-0019","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.0","Z30.011","Z11.3","R63.4","R10.9","R11.2","O20.9","Z3A.01","J03.90","J35.8","R59.0","J35.1","Z30.016","Z32.02","O98.511","O99.331","O23.41","U07.1","R50.9","O21.9","Z87.440","Z3A.16","D50.8","I49.9","R19.7","R10.30","R21.","Z79.3","F32.9","R55.","Z79.899","Z34.01","Z3A.12","J02.9","NO DATA","R09.89","R51.9","Z20.822","O43.192","O99.891","N89.8","Z3A.20","D64.9","Z11.4","Z3A.08"],"date":["2022-08-15","2021-03-23","2022-03-17","2021-03-23","2021-10-22","2021-10-22","2022-08-15","2022-08-15","2020-08-28","2020-08-28","2020-08-28","2020-08-28","2022-03-17","2022-03-17","2022-08-15","2022-08-15","2022-08-15","2022-08-15","2022-08-15","2022-10-20","2022-10-20","2022-10-20","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2020-06-24","2022-09-22","2022-09-22","2022-03-02","2022-03-02","2022-03-02","2022-03-02","2022-03-02","2022-11-17","2022-11-17","2022-11-17","2022-11-17","2020-01-31","2022-08-24","2022-08-24"],"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":[["","65162035803","ZAFEMY","DIS 150\/35","3","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","00555902658","JUNEL","TAB 44581","84","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","13","Select","Select",""],["","57896070310","IRON","TAB 325MG","90","Select","Select",""],["","50742019001","CYPROHEPTAD","TAB 4MG","90","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","14","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","2","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","15","Select","Select",""],["","43292055581","CALCIUM","TAB 500MG","90","Select","Select",""],["","75834002001","VITAMIN","CAP 50000UNT","8","Select","Select",""],["","69784018014","POLYETH","POW 3350 NF","14","Select","Select",""],["","00904642285","PEG","POW ","14","Select","Select",""],["","51663000500","OPTIMAL-D","CAP 50000UNT","8","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":""}]}]}