{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PENNY   A AHLBERG","gend":1,"add":"10408 GOOSE CREEK ROAD","city":"BRISTOL","state":"VA","zip":"24202-9998","dob":"1969-08-21","age":"","mstatus":"","insh":"2139263*01","cliId":"","pno":"276\/669-3048","cno":"276\/669-3048","email":"","ename":"","eno":"","pphy":"WHILES, RICK J MD","ppno":"423\/990-2414","pcpadd":"SUITE 3600 240 MEDICAL PARK BLVD","pcpcity":"BRISTOL","pcpstate":"TN","pcpzip":37620,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"423\/990-2417","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","B37.9","R42.","N30.00","R04.2","R06.02","N39.0","Z20.828","N30.20","J32.9","R22.30","R39.9","R55.","Z87.19","K59.00","K64.9","K62.5","R56.9","I44.7","I42.0","R07.2","M79.606","R30.0","G60.9","R00.2","B37.3","R10.9","K57.90","I42.8","E78.2","F17.210","R10.84","Z12.31","Z78.0","F41.9","R10.31","K63.3","K55.9","Z86.010","Z83.71"],"date":["2021-08-06","2020-02-08","2020-02-12","2020-02-12","2020-02-12","2020-10-19","2022-09-26","2020-11-13","2022-08-17","2022-06-01","2022-06-01","2022-09-27","2020-02-17","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2021-01-04","2020-02-18","2020-02-18","2020-12-22","2022-09-26","2021-10-22","2021-10-22","2021-01-11","2022-02-09","2022-02-08","2021-01-04","2021-01-04","2021-01-04","2020-02-18","2021-03-29","2021-03-29","2021-03-29","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-06-29"],"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":[["","65862078201","METHENAM","TAB 1GM","145","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","30","Select","Select",""],["","57237010099","METOPROL","TAB 25MG","90","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","45802005911","NYSTATIN","CRE 100000","30","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","52565004215","NYSTAT\/TRIAM","OIN ","30","Select","Select",""],["","16729000517","SIMVASTATIN","TAB 20MG","30","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","28","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","52536013301","MECLIZINE","TAB 25MG","30","Select","Select",""],["","45802005535","TRIAMCINOLON","OIN 0.001","30","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","40","Select","Select",""],["","49035056314","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","49035023814","EQ","CAP SOFTENER","60","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00093220301","METOCLOPRAM","TAB 10MG","20","Select","Select",""],["","00603015032","DOCQLACE","CAP 100MG","60","Select","Select",""],["","51224000160","BENZONATATE","CAP 200MG","20","Select","Select",""],["","43386033001","TRIMETHOPRIM","TAB 100MG","90","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","51293081101","PHENAZOPYRID","TAB 200MG","10","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":""}]}]}