{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAURRISSA FRALEY","gend":1,"add":"350 PAGE ST","city":"BRISTOL","state":"VA","zip":"24201-9998","dob":"2004-11-03","age":"","mstatus":"","insh":"2182705*01","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"MCCLINTIC, ANDREA DO","ppno":"276\/669-5179","pcpadd":"2195 EUCLID AVE SUITE 6","pcpcity":"BRISTOL","pcpstate":"VA","pcpzip":24201,"pcpcounty":"","pcpid":"","pcpname":"SOUTHWEST VIRGINIA COMMUNITY HEALTH SYSTEMS INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/466-8870","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E55.9","R19.7","K21.9","B34.9","K20.0","R13.10","R10.84","J30.1","J30.89","J30.5","L27.2","H65.113","H10.45","K58.9","J30.81","L20.81","H69.80","Z01.818","M25.571","F43.9","R55.","R42.","M25.522","J30.9","R51.9","Z79.899","Z77.22","H92.09","R10.13","J30.2","S93.402A","S42.402A","F45.8","K52.9","Z20.828","S99.911A","Z91.018","Q61.00","Z86.69","J45.20","K59.00","R11.0","M25.579","V58.89","G43.019","G44.40","J32.9","R05.9","F32.5","Z11.59","R19.5","F63.3","Z30.017","H65.23","L23.0","F40.10","R41.0","R10.32","S93.401S","R26.9","J40.","L20.9","F41.1","F32.9","G43.909","G43.709","Z71.3","M54.6","M41.9","F41.9"],"date":["2022-03-10","2022-03-25","2022-09-19","2019-04-18","2022-09-19","2022-09-19","2020-04-08","2022-11-18","2022-11-18","2022-09-01","2020-10-09","2022-08-12","2022-08-12","2019-09-04","2022-11-18","2020-04-10","2020-04-10","2020-10-15","2021-12-02","2022-10-27","2022-11-08","2021-09-30","2019-10-30","2022-09-21","2022-03-10","2021-10-08","2021-10-08","2021-10-08","2021-12-10","2021-03-31","2021-12-03","2019-09-17","2021-09-30","2020-03-03","2020-10-15","2021-11-23","2022-09-21","2019-05-14","2019-05-14","2019-09-20","2021-03-08","2022-03-10","2021-12-03","2022-02-02","2022-04-07","2022-03-15","2022-06-01","2022-06-01","2022-06-01","2022-03-10","2022-03-10","2022-03-10","2022-03-10","2022-09-21","2022-09-21","2022-03-15","2022-04-01","2022-09-19","2022-02-11","2022-02-11","2022-06-24","2022-08-12","2022-04-05","2022-04-05","2022-04-05","2022-06-22","2022-06-22","2022-04-02","2022-04-02","2022-04-02"],"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":[["","00603548221","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","00054027803","NARATRIPTAN","TAB 1MG","9","Select","Select",""],["","16714079904","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","55111053401","DIVALPROEX","TAB 500MG ER","60","Select","Select",""],["","68645052154","SERTRALINE","TAB 25MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","9","Select","Select",""],["","00093914801","VENLAFAXINE","TAB 37.5MG","30","Select","Select",""],["","","OMEPRAZOLE"," OMEPRAZOLE ","30","Select","Select",""],["","55111011890","FAMOTIDINE","TAB 10MG","60","Select","Select",""],["","00074709430","QULIPTA","TAB 60MG","30","Select","Select",""],["","00115180401","HYDROXYZ","CAP 50MG","30","Select","Select",""],["","49035013606","EQ","PAD 0.04","3","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","49035045875","ALLERGY","TAB 10MG","30","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","15","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00591079401","DICYCLOMINE","CAP 10MG","90","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","69784018014","POLYETH","POW 3350 NF","14","Select","Select",""],["","00573266024","ALAVERT","TAB \/SINUS","20","Select","Select",""],["","41167431004","ALLEGRA-D","TAB 12 HOUR","20","Select","Select",""],["","00113201339","ALLERGY\/CONG","TAB 5-120MG","20","Select","Select",""],["","33342009441","RIZATRIPTAN","TAB 10MG ODT","9","Select","Select",""],["","11523716202","CLARITIN-D","TAB 5-120MG","20","Select","Select",""],["","70000004801","ACID","TAB 10MG","60","Select","Select",""],["","65862014836","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","10702025301","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","00093081001","NORTRIPTYLIN","CAP 10MG","30","Select","Select",""],["","65862017160","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","","PROMETHAZINE","TAB 12.5MG","","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":""}]}]}