{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA   A STILES","gend":1,"add":"PO BOX 1312","city":"EASTVILLE","state":"VA","zip":"23347-9998","dob":"1978-02-19","age":"","mstatus":"","insh":"6972985*01","cliId":"","pno":"757\/678-2423","cno":"","email":"","ename":"","eno":"","pphy":"GILES, IAN MD","ppno":"757\/331-1086","pcpadd":"17068 LANKFORD HWY","pcpcity":"EASTVILLE","pcpstate":"VA","pcpzip":23347,"pcpcounty":"","pcpid":"","pcpname":"EASTERN SHORE RURAL HEALTH SYSTEM INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/442-9505","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","H40.013","Z12.83","C44.319","D22.72","L57.0","F12.20","F14.20","Z76.89","Z79.899","L90.5","L57.4","L82.1","Z85.828","N92.1","E03.9","F31.9","F17.210","C44.01","R73.02","Z11.59","Z11.4","Z71.3","E66.09","Z68.33","F43.10","C44.311","R31.9","R30.0","R42.","F31.30","H61.21","Z68.32","F41.9","F32.9","K21.9","Z68.36","R50.9","J02.9","R09.81","R05.","N92.6","Z68.34","Z23.","D22.5","L57.3","L81.2","D48.5","L98.9","R23.4","B07.0","M77.41","M77.42","M79.89"],"date":["2021-09-22","2021-02-09","2020-09-01","2020-09-01","2020-09-01","2020-09-01","2021-08-11","2021-08-11","2021-08-04","2021-07-02","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2020-04-17","2021-04-26","2021-05-07","2021-07-02","2020-05-27","2021-04-26","2021-04-26","2021-04-26","2021-07-02","2021-07-02","2021-04-26","2021-09-24","2020-06-30","2020-07-31","2020-07-31","2021-07-02","2021-07-02","2021-07-02","2021-07-02","2020-09-30","2020-09-30","2020-09-30","2020-03-18","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2020-05-21","2020-09-30","2020-09-30","2019-07-05","2019-07-05","2019-07-05","2019-07-05","2019-06-03","2019-01-29","2019-12-03","2019-09-20","2019-09-20","2019-09-20"],"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":[["","51672400501","CARBAMAZEPIN","TAB 200MG","150","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","35","Select","Select",""],["","59746024860","LAMOTRIGINE","TAB 200MG","30","Select","Select",""],["","00536589488","NICOTINE","DIS 7MG\/24HR","14","Select","Select",""],["","62332005471","CLONIDINE","TAB 0.1MG","90","Select","Select",""],["","62175013643","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","67877024601","QUETIAPINE","TAB 200MG","45","Select","Select",""],["","57237017099","ROSUVASTATIN","TAB 20MG","90","Select","Select",""],["","00781518010","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","59676058015","JANSSEN","INJ COVID-19","0","Select","Select",""],["","50228014590","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","64980037503","ATOMOXETINE","CAP 25MG","30","Select","Select",""],["","59746012110","MECLIZINE","TAB 25MG","30","Select","Select",""],["","00781723864","BUPREN\/NALOX","MIS 8-2MG","35","Select","Select",""],["","","IMIQUIMOD","CRE 0.05","","Select","Select",""],["","","PYRIDIUM","TAB 200MG","","Select","Select",""],["","","NARCAN","SPR ","","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","13668057410","LACTULOSE","SOL 10GM\/15","946","Select","Select",""],["","45963043864","ENULOSE","SOL 10GM\/15","946","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":""}]}]}