{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CRYSTAL POWERS","gend":1,"add":"115 MARK DR","city":"COLONIAL BEACH","state":"VA","zip":"22443-9998","dob":"1964-01-23","age":"","mstatus":"","insh":"2153751*01","cliId":"","pno":"540\/836-3441","cno":"540\/836-3441","email":"","ename":"","eno":"","pphy":"JOSEPH, CHERIAN MD","ppno":"540\/242-4141","pcpadd":"STE 120 3920 PLANK RD","pcpcity":"FREDERICKSBURG","pcpstate":"VA","pcpzip":22407,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/786-2396","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","M10.9","Z71.89","Z71.3","E55.9","E03.9","I10.","F33.9","E87.6","NO DATA","Z21.","Z23.","M17.0","F11.21","B20.","R01.1","H53.8","J44.9","G89.29","Z79.899","B18.2","F11.11","E66.9","R13.10","R10.13","R63.4","Z86.010","Z13.220","R60.9"],"date":["2021-07-20","2021-09-10","2021-09-10","2021-06-22","2021-09-10","2021-09-10","2021-09-10","2021-09-10","2020-09-10","2022-05-17","2020-09-10","2020-09-10","2021-09-10","2020-07-30","2022-05-17","2022-05-17","2022-05-17","2022-05-17","2022-05-17","2020-09-01","2021-09-10","2021-06-22","2021-09-10","2022-01-11","2022-01-11","2022-01-11","2022-01-11","2020-04-02","2021-09-10"],"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":[["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","61958250101","BIKTARVY","TAB ","30","Select","Select",""],["","00254200801","COLCHICINE","TAB 0.6MG","28","Select","Select",""],["","51991074810","DULOXETINE","CAP 60MG","30","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00378180310","LEVOTHYROXIN","TAB 50MCG","30","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","5","Select","Select",""],["","71930002643","BROM\/PSE\/DM","SYP ","100","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","70710121005","ALLOPURINOL","TAB 300MG","90","Select","Select",""],["","68180079901","POT  CHLORIDE","CAP 10MEQ ER","30","Select","Select",""],["","55111046701","METOPROL","TAB 50MG ER","30","Select","Select",""],["","59779041525","ALLERGY","CAP 10MG","25","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","13","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","12496120203","SUBOXONE","MIS 2-0.5MG","18","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","120","Select","Select",""],["","61442010310","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","70436005901","BUPROPION","TAB 150MG SR","90","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","180","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","47781035503","BUPREN\/NALOX","MIS 2-0.5MG","21","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","70436001002","BUPROPN","TAB 150MG XL","30","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":""}]}]}