{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA GUGEL","gend":1,"add":"155 RONNER LN","city":"WINCHESTER","state":"VA","zip":"22603-9998","dob":"1973-02-05","age":"","mstatus":"","insh":"2146334*01","cliId":"","pno":"540\/722-8908","cno":"","email":"","ename":"","eno":"","pphy":"AGYEIWAAH, MAVIS A MD","ppno":"540\/536-5400","pcpadd":"1440 AMHERST ST","pcpcity":"WINCHESTER","pcpstate":"VA","pcpzip":22601,"pcpcounty":"","pcpid":"","pcpname":"VALLEY PHYSICIAN ENTERPRISE INC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/536-5490","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H25.13","H25.812","R10.13","K21.9","R13.19","D50.9","E66.3","K25.3","K25.7","K31.1","R59.0","V58.89","E87.6","J44.9","F17.210","Z23.","Z99.81","H60.10","F41.1","R03.0","F11.20","R00.0","F41.0","J96.00","J96.11","R09.02","R41.82","F51.01","R21.","L85.9","K64.8","R60.0","J96.01","Z03.818","J30.9","T40.3X1A","G92.","J96.02","J44.1","Z20.828","E78.5","J31.0","G47.00","I10.","Z79.51","Z82.49","H25.811","H26.9","R53.83","B00.4","B00.9","Z76.89","N80.9","K25.9","K22.8","R06.02","F29.","H40.033","H25.9","Z79.899","E78.00","S00.432A","X58.XXXA","H25.11","R09.81","H25.89","H25.12","Z12.39"],"date":["2019-02-21","2019-05-13","2020-01-03","2020-11-18","2020-01-03","2020-03-17","2019-12-24","2020-02-04","2020-02-04","2020-02-04","2020-12-04","2020-12-04","2020-12-04","2021-12-31","2020-12-04","2020-12-04","2021-06-15","2020-08-10","2020-08-10","2020-08-10","2020-11-19","2020-08-10","2020-08-10","2020-11-18","2021-01-29","2021-12-25","2021-12-25","2020-06-17","2019-05-17","2019-05-17","2020-01-03","2020-10-01","2020-11-19","2020-11-19","2020-11-19","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2020-11-18","2019-03-18","2019-05-13","2019-04-19","2019-04-19","2020-06-17","2019-04-19","2019-11-18","2020-02-04","2020-02-04","2020-03-13","2020-11-18","2019-02-04","2019-03-12","2019-03-12","2020-06-17","2021-07-01","2021-06-15","2019-03-18","2020-10-01","2019-01-17","2019-05-13","2020-02-18"],"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":{"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":[["","","PREDNISOLONE"," PREDNISOLONE ","5","Select","Select",""],["","","OFLOXACIN"," OFLOXACIN ","10","Select","Select",""],["","","VALACYCLOVIR"," VALACYCLOVIR ","30","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","","TRAZODONE"," TRAZODONE ","30","Select","Select",""],["","","TRIAMCINOLON"," TRIAMCINOLON ","15","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","CVS","DIS 21MG\/24H","","Select","Select",""],["","","SYMBICORT","AER 160-4.5","","Select","Select",""],["","","ATORVASTATIN","TAB 20MG","","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","","MUPIROCIN","OIN 0.02","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","","HYDROXYZ","CAP 25MG","","Select","Select",""],["","","CLONIDINE","TAB 0.1MG","","Select","Select",""],["","","NICOTINE","DIS 21MG\/24H","","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","","OPTICHAMBER","MIS DIA SM","","Select","Select",""],["","","PROVENTIL","AER HFA","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","FUROSEMIDE","TAB 20MG","","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":""}]}]}