{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SAMANTHA PACK","gend":1,"add":"124 16TH ST","city":"PULASKI","state":"VA","zip":"24301-9998","dob":"1991-07-21","age":"","mstatus":"","insh":"2152871*01","cliId":"","pno":"540\/808-6844","cno":"","email":"","ename":"","eno":"","pphy":"ROSBOROUGH, RANIA B MD","ppno":"540\/731-1600","pcpadd":"614 E MAIN ST STE B","pcpcity":"RADFORD","pcpstate":"VA","pcpzip":24141,"pcpcounty":"","pcpid":"","pcpname":"LEWIS GALE PHYSICIANS LLC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/731-0720","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J32.9","Z71.89","H92.03","Z3A.29","Z34.83","Z23.","M54.6","Z33.1","M99.02","M99.03","R00.0","L25.5","Z30.430","Z32.02","M62.838","M62.830","R07.89","Z87.891","S33.5XXA","M99.01","M99.08","O70.1","O69.81X0","Z37.0","Z3A.39","N93.9","Z32.01","G44.209","M99.07","J02.9","M79.89","O80.","Z3A.00","R19.7","R31.9","K92.1","D72.829","R79.89","R30.0","D64.9","K90.41","R03.0","Z20.822","R09.81","J01.90","O90.89","H66.90","D23.9","Z80.8","L30.9","M54.5","K21.9"],"date":["2020-04-19","2021-01-12","2020-04-19","2020-02-03","2020-02-03","2020-02-03","2020-03-23","2020-03-23","2020-03-23","2020-03-09","2020-04-15","2021-09-16","2020-06-04","2020-06-04","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2019-01-14","2020-03-23","2020-03-23","2020-04-15","2020-04-15","2020-04-15","2020-04-15","2019-08-20","2019-08-20","2020-02-19","2020-02-19","2021-09-16","2020-04-16","2020-04-15","2020-04-15","2020-11-10","2021-01-11","2021-01-11","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2020-11-10","2021-12-26","2021-12-26","2021-12-26","2020-04-14","2020-11-12","2021-01-12","2021-01-12","2021-09-16","2019-08-04","2021-01-11"],"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":[["","","DEXAMETHASON"," DEXAMETHASON ","10","Select","Select",""],["","","ORPHENADRINE"," ORPHENADRINE ","10","Select","Select",""],["","","DICLOFENAC"," DICLOFENAC ","20","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","18","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","30","Select","Select",""],["","","CYCLOBENZAPR"," CYCLOBENZAPR ","15","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","ANTIFUNGAL","CRE 0.02","","Select","Select",""],["","","MICONAZOLE","CRE 0.02","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","MUCUS","TAB 600MG ER","","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":""}]}]}