{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GINA   A CARTER","gend":1,"add":"3632 MASSAPONAX CHURCH ROAD","city":"FREDERICKSBURG","state":"VA","zip":"22408-9998","dob":"1972-10-03","age":"","mstatus":"","insh":"2296459*01","cliId":"","pno":"540\/273-1847","cno":"540\/273-1847","email":"","ename":"","eno":"","pphy":"VALDES-DAPENA, ANTONIO MD","ppno":"804\/633-5840","pcpadd":"121 COURTHOUSE LANE","pcpcity":"BOWLING GREEN","pcpstate":"VA","pcpzip":22427,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/633-4438","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F39.","R10.84","Z20.828","R05.","I50.9","R06.02","M48.00","Z87.891","Z82.49","R00.0","Z03.818","R91.8","R06.00","R06.2","Z79.899","R06.09","Z72.0","K50.90","K21.9","E66.9","Z79.52","Z68.33","K52.9","Z11.59","S93.601A","E78.5","F41.8","U07.1","R10.33","I49.9","R94.31","L72.0","J96.01","M54.12","M54.16","M43.23","M51.36","Z20.822","F41.9","G89.29","M54.5","Z12.31","Z12.4","I10.","K50.919","Z00.00","R06.03","Q96.3","Z20.5","J00.","J06.9","B34.2","B97.29","I50.23","NO DATA","M79.7","M32.9","M06.4","M50.20","F32.9","F17.290","Z87.19","Z91.5","R06.01","G62.9","Z23.","F41.1","R09.02","R93.89","J18.9","Z86.16","Z81.8","Z79.51","Z28.310"],"date":["2022-09-06","2020-09-03","2020-10-30","2020-12-07","2021-07-28","2022-09-08","2020-10-30","2022-09-09","2022-09-09","2020-10-30","2020-10-30","2021-03-03","2020-12-02","2020-12-07","2021-03-03","2020-11-03","2020-07-07","2022-09-09","2021-03-03","2020-12-04","2020-12-04","2020-12-04","2021-03-03","2021-03-03","2021-06-01","2020-11-03","2020-11-03","2021-10-31","2021-10-31","2020-10-15","2020-10-30","2022-04-15","2022-09-09","2021-03-19","2020-08-13","2020-08-13","2020-08-13","2022-09-09","2022-03-31","2021-06-21","2021-06-21","2021-06-21","2021-06-21","2022-09-09","2021-06-21","2021-06-21","2022-09-08","2020-11-03","2021-05-14","2020-05-22","2020-05-22","2020-05-22","2020-05-22","2020-10-30","2020-10-30","2022-09-09","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2021-01-05","2021-03-19","2021-03-19","2022-09-08","2022-09-08","2022-09-09","2022-09-09","2022-09-09","2022-09-09","2022-09-09"],"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":[["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","29300011416","LAMOTRIGINE","TAB 200MG","90","Select","Select",""],["","59762135101","PREGABALIN","CAP 150MG","90","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","23155050205","HYDROXYZ","TAB 50MG","180","Select","Select",""],["","27241009990","DULOXETINE","CAP 60MG","180","Select","Select",""],["","68180032009","BUPROPN","TAB 300MG XL","90","Select","Select",""],["","27241000506","RISPERIDONE","TAB 3MG","60","Select","Select",""],["","55111046705","METOPROL","TAB 50MG ER","60","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00378021610","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","69543038130","OLANZAPINE","TAB 5MG","30","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","20","Select","Select",""],["","68180065208","DOXYCYC","CAP 100MG","20","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","00456240560","SAPHRIS","SUB 5MG","60","Select","Select",""],["","42794001610","ASENAPINE","SUB 5MG","60","Select","Select",""],["","37205067462","TABTUSSIN","TAB 400MG","24","Select","Select",""],["","55111025660","ZIPRASIDONE","CAP 20MG","3","Select","Select",""],["","00071101668","LYRICA","CAP 150MG","90","Select","Select",""],["","61874013030","VRAYLAR","CAP 3MG","30","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","55111016905","QUETIAPINE","TAB 50MG","60","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00904679480","ASPIRIN","CHW 81MG","30","Select","Select",""],["","42571016201","AMOX\/K","TAB 875-125","20","Select","Select",""],["","13668015490","ESOMEPRA","CAP 20MG DR","90","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":""}]}]}