{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JANICE   M SPENCE","gend":1,"add":"4878 LEE HWY CT LOT 53","city":"DUBLIN","state":"VA","zip":"24084-9998","dob":"1973-04-22","age":"","mstatus":"","insh":"2199646*01","cliId":"","pno":"540\/980-6496","cno":"540\/980-6496","email":"","ename":"","eno":"","pphy":"ULLMAN, CHRISTINE DO","ppno":"540\/674-8805","pcpadd":"118 BROAD ST","pcpcity":"DUBLIN","pcpstate":"VA","pcpzip":24084,"pcpcounty":"","pcpid":"","pcpname":"Carilion Clinic Family Medicine Dublin","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE\/ ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/674-8670","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M77.8","Z71.89","G56.03","F32.3","E55.9","E78.00","F41.9","R44.3","G45.9","G81.90","R73.9","R63.5","U07.1","Z20.822","R50.9","R05.1","F15.10","NO DATA","Z63.4","F15.20","H35.89","R19.7","J30.89","J44.1","Z72.0","J20.9","R06.2","R05.","F11.20","R07.81","R11.2","F41.8"],"date":["2020-01-15","2020-04-23","2020-01-15","2020-06-01","2020-06-01","2020-06-01","2022-06-30","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2021-12-29","2022-11-16","2021-12-29","2021-12-29","2022-06-30","2022-06-30","2022-06-30","2021-09-16","2022-01-27","2022-11-13","2022-11-13","2022-11-16","2022-11-16","2020-04-23","2020-04-23","2020-04-23","2022-08-12","2021-02-07","2021-07-08","2020-05-21"],"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":[["","00093005301","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","5","Select","Select",""],["","43598065530","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","68382009810","PAROXETINE","TAB 20MG","30","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","31722095801","BENZONATATE","CAP 200MG","15","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","21","Select","Select",""],["","69784050001","EC-NAPROXEN","TAB 500MG","14","Select","Select",""],["","57237007830","ONDANSETRON","TAB 8MG ODT","15","Select","Select",""],["","00085113201","PROVENTIL","AER HFA","7","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","16714035101","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","00555032302","HYDROXYZ","CAP 25MG","45","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}