{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JULIA SHEPHERD","gend":1,"add":"355 BRISTOL EAST RD APT D","city":"BRISTOL","state":"VA","zip":"24202-9998","dob":"1978-07-20","age":"","mstatus":"","insh":"2284017*01","cliId":"","pno":"276\/469-2739","cno":"276\/469-2739","email":"","ename":"","eno":"","pphy":"HERNDON, TASHA N NP","ppno":"276\/285-3911","pcpadd":"170 BLEVINS BLVD","pcpcity":"BRISTOL","pcpstate":"VA","pcpzip":24202,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"276\/285-3920","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F17.210","E66.9","K46.9","F19.982","F17.211","G89.4","F41.1","F32.2","F33.1","F15.21","F19.230","F13.20","F15.20","F32.9","F17.200","F15.10","I10.","E03.9","T50.995A","E66.09","M54.5","F12.20","Z63.4","Z72.0","R60.0","K04.7","F12.21","G90.09","F33.9","S39.92XA"],"date":["2022-03-28","2022-01-26","2022-01-26","2020-07-08","2020-04-22","2020-04-22","2020-05-27","2022-03-28","2020-06-10","2022-03-28","2021-05-05","2021-08-25","2022-03-28","2022-03-28","2021-11-10","2020-03-25","2020-03-25","2022-02-07","2020-03-25","2020-10-14","2021-06-30","2021-08-25","2021-12-01","2021-12-29","2020-03-25","2021-11-17","2022-03-14","2021-03-24","2020-07-29","2021-05-05","2021-08-25"],"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":[["","60505015701","BUPROPION","TAB 100MG","60","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","49","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","84","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","70","Select","Select",""],["","68180031909","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00597002402","COMBIVENT","AER 20-100","4","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","60","Select","Select",""],["","42543005263","NYSTATIN","POW 100000","60","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00574200802","NYSTOP","POW 100000","60","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","60","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","24","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","61314064610","NEO\/POLY\/HC","SOL 1% OTIC","10","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","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":""}]}]}