{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROSALYN   J DAVIS","gend":1,"add":"4152 BETHEL ROAD","city":"SCOTTSBURG","state":"VA","zip":"24589-9998","dob":"1979-05-22","age":"","mstatus":"","insh":"7388535*01","cliId":"","pno":"434\/579-4781","cno":"434\/579-4781","email":"","ename":"","eno":"","pphy":"ROBERTS, MAURICE NP","ppno":"434\/835-4876","pcpadd":"3130 HALIFAX ROAD SUITE C","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":24592,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/835-4875","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R68.82","M75.42","R21.","R60.0","L29.8","Z11.59","Z20.828","A08.4","R11.2","R19.7","Z01.419","Z12.39","G43.709","R11.0","M25.552","M65.312","M70.62","D25.2","N83.8","D25.1","D06.9","G47.00","G43.909","Z88.8","Z88.1","Z88.5","Z88.6","E66.9","Z68.37","S90.31XA","R10.9","F32.9","H92.02","N92.0","Z30.432","G89.4","Z88.2","Z79.891","Z79.899","R51.9","H53.8","R10.13","R10.10","N93.9","Z86.16","Z51.81","R87.613","Z32.02","N87.1","Z01.818","K29.70","K21.9","K59.00","M65.311","N90.89","R42.","F40.298","G51.0","NO DATA","Z85.41","K59.04","K29.50","G89.29","Z80.0","Z87.19","R11.10","Z20.822","U07.1","Z01.812","F11.10","L29.2","N39.0","R31.9","Z90.710","R30.0","J01.90","J02.9","F41.9","N93.8","R53.1","Z79.2","R20.2","R50.9","R00.0","R19.4","R10.84","K58.1","M25.512","B34.9","Z01.810","K64.9","K59.03","Z98.51","Z80.3","Z82.49","Z82.61","Z80.49","Z53.20","G43.109","J06.9","R05.","R09.81","R51.","M26.601","M26.621","R68.84","T83.32XA","L30.9","F32.1","R11.11","R63.4","Z01.89"],"date":["2022-08-24","2020-03-05","2020-08-18","2020-08-18","2020-08-18","2020-08-18","2021-10-12","2021-04-21","2022-04-23","2022-04-23","2021-11-23","2021-11-23","2022-09-27","2022-11-02","2022-01-14","2022-02-24","2022-01-31","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-02-07","2022-11-02","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-02-07","2022-02-07","2022-03-10","2022-08-19","2021-09-29","2020-02-18","2021-09-27","2020-12-09","2022-11-02","2021-08-17","2022-09-27","2022-08-05","2022-11-02","2022-05-13","2021-08-31","2021-08-31","2022-02-07","2021-10-21","2022-05-10","2021-12-13","2021-12-13","2021-12-22","2022-09-15","2022-08-05","2022-08-19","2022-08-05","2022-10-05","2022-10-17","2022-11-02","2022-11-02","2022-11-02","2022-11-02","2022-11-02","2022-08-05","2022-08-05","2022-08-19","2022-08-19","2022-08-05","2021-04-21","2022-02-21","2021-10-07","2022-09-15","2022-06-29","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2022-08-18","2020-02-14","2020-02-14","2020-12-09","2021-09-16","2021-09-16","2021-09-16","2021-10-06","2021-10-06","2021-10-06","2022-08-19","2022-08-19","2022-08-19","2020-03-23","2021-09-29","2022-09-15","2022-04-02","2022-04-02","2022-04-02","2022-04-02","2022-04-02","2022-04-02","2022-04-02","2022-06-08","2022-06-14","2020-05-01","2020-05-01","2020-05-01","2020-05-01","2020-07-27","2020-07-27","2020-07-27","2020-11-17","2022-08-18","2020-06-12","2022-04-23","2022-06-16","2022-06-16"],"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":[["","59746017210","PREDNISONE","TAB 5MG","10","Select","Select",""],["","65162011511","HYDROCO\/APAP","TAB 7.5-325","48","Select","Select",""],["","00904699880","DOCUSATE","CAP 100MG","14","Select","Select",""],["","00456120230","LINZESS","CAP 290MCG","30","Select","Select",""],["","00555077902","MEDROXYPR","TAB 10MG","30","Select","Select",""],["","00904671980","ACETAMINOPHE","TAB 325MG","90","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","26","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","67877024210","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","69584061150","METHOCARBAM","TAB 500MG","30","Select","Select",""],["","00713050312","ANUCORT-HC","SUP 25MG","10","Select","Select",""],["","47781019605","OXYCOD\/APAP","TAB 5-325MG","8","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","45802011222","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","57237023305","SMZ-TMP","TAB 800-160","10","Select","Select",""],["","10702000310","PROMETHAZINE","TAB 25MG","10","Select","Select",""],["","00536117801","MECLIZINE","TAB 12.5MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68462030450","NORETHIN","TAB 5MG","60","Select","Select",""],["","51224002218","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","14","Select","Select",""],["","55111068405","IBU","TAB 800MG","42","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","63868008901","ARTHRTS","TAB 650MG","42","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","57896090101","ASPIRIN","TAB 325MG","30","Select","Select",""],["","33342032815","TRIAMCINOLON","CRE 0.005","15","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":""}]}]}