{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY MARKLEY","gend":1,"add":"4 EDEN ROAD","city":"LURAY","state":"VA","zip":"22835-9998","dob":"1980-12-23","age":"","mstatus":"","insh":"2172382*01","cliId":"","pno":"540\/742-2380","cno":"540\/742-2380","email":"","ename":"","eno":"","pphy":"LEE, R DAVID MD","ppno":"540\/743-2887","pcpadd":"135 MEMORIAL DRIVE","pcpcity":"LURAY","pcpstate":"VA","pcpzip":22835,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/743-1288","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F15.20","R42.","S09.90XS","M54.2","G89.29","F41.9","R51.9","Z78.9","W22.8XXA","R39.9","R35.0","K04.7","M54.5","F31.70","B37.0","R53.83","E03.9","R82.90","J02.9","R05.9","J06.9","Z20.822","R00.0","R00.2","I51.7","R06.02","F17.200","R07.9","N95.1","R23.2","R45.86","L30.9","J30.9","M79.601","J44.1","E87.6","R40.0","R53.1","Z79.899","R05.","R50.9","R09.1","M50.30","M54.12","M47.812","M25.512","R41.82","M62.81"],"date":["2022-09-26","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2022-09-13","2020-02-13","2020-02-13","2020-03-17","2020-02-13","2021-09-27","2020-03-17","2022-08-29","2020-11-11","2020-08-25","2022-01-25","2021-12-22","2021-12-22","2022-08-29","2022-07-26","2022-08-08","2022-07-13","2022-07-26","2022-06-22","2022-07-26","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2020-11-11","2021-12-11","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2020-08-13","2022-01-25","2021-07-08","2022-04-08","2022-04-08","2022-04-08","2022-04-22","2022-08-29","2022-09-13"],"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":[["","60505015801","BUPROPION","TAB 75MG","60","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","55111025660","ZIPRASIDONE","CAP 20MG","30","Select","Select",""],["","65757030001","VIVITROL","INJ 380MG","1","Select","Select",""],["","65862017360","TOPIRAMATE","TAB 100MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","31722054501","LITHIUM","CAP 300MG","120","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","65862052405","GABAPENTIN","TAB 800MG","120","Select","Select",""],["","68180044501","QUETIAPINE","TAB 25MG","60","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","90","Select","Select",""],["","62332002891","LOSARTAN","TAB 50MG","90","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","00054018913","BUPREN\/NALOX","SUB 8-2MG","5","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","28","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","90","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","12496030001","SUBLOCADE","INJ 300\/1.5","2","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","16714075601","ATOMOXETINE","CAP 18MG","30","Select","Select",""],["","16571066101","MECLIZINE","TAB 25MG","20","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","28","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","90","Select","Select",""],["","13107000130","MIRTAZAPINE","TAB 7.5MG","90","Select","Select",""],["","29300011101","LAMOTRIGINE","TAB 25MG","42","Select","Select",""],["","16729017117","AMITRIPTYLIN","TAB 10MG","30","Select","Select",""],["","68462029052","AUG","CRE 0.0005","50","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","40","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","45963014205","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","59148003813","REXULTI","TAB 2MG","30","Select","Select",""],["","68180013701","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","29300013901","DIVALPROEX","TAB 250MG DR","60","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","69543038810","KETOROLAC","TAB 10MG","10","Select","Select",""],["","00186091706","PULMICORT","INH 90MCG","1","Select","Select",""],["","68645057154","CITALOPRAM","TAB 40MG","90","Select","Select",""],["","29300013501","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","11523433203","CLARITIN-D","TAB 10-240MG","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":""}]}]}