{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIRA JACKSON","gend":1,"add":"1615 CHAPT ICO ROAD","city":"SOUTH HILL","state":"VA","zip":"23970-9998","dob":"2001-12-21","age":"","mstatus":"","insh":"7706413*01","cliId":"","pno":"434\/262-4974","cno":"434\/262-4974","email":"","ename":"","eno":"","pphy":"POWERS, DAVID C MD","ppno":"434\/584-2025","pcpadd":"514 W ATLANTIC ST","pcpcity":"SOUTH HILL","pcpstate":"VA","pcpzip":23970,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/447-2240","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z23.","R00.2","I49.1","F41.1","F33.1","I95.1","I49.8","G90.9","F90.2","F41.0","G47.9","F90.9","F41.9","F32.9","J30.9","F41.8","N39.0","R55.","L70.0","L30.0","L68.9","G90.1","Z90.89","J02.9","J20.9","Z68.22","G90.8","Z79.899","G47.00","G47.21","I49.9","R09.81","J01.90","F33.0","Z20.828","H93.13","R42.","H69.83","Z00.00","F42.2","N60.19","R11.0","F33.42","F51.04"],"date":["2021-04-06","2021-03-02","2021-03-02","2022-11-08","2022-08-08","2022-07-11","2022-02-11","2021-05-11","2022-11-08","2022-08-08","2021-08-26","2021-08-26","2021-09-28","2022-02-11","2022-08-02","2020-01-29","2020-02-26","2020-02-26","2021-04-19","2021-04-19","2021-04-19","2021-09-28","2021-09-28","2022-11-23","2022-11-23","2022-11-23","2020-04-22","2022-06-02","2020-06-08","2020-06-08","2021-01-06","2021-01-18","2021-01-18","2021-07-07","2021-08-31","2022-08-02","2022-08-02","2022-08-02","2021-03-04","2021-04-08","2022-05-02","2022-05-02","2022-11-08","2022-11-08"],"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":[["","00093078701","ATENOLOL","TAB 25MG","90","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","68645052254","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00245021311","MIDODRINE","TAB 10MG","90","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","16714020030","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","55513080060","CORLANOR","TAB 5MG","30","Select","Select",""],["","00406012501","HYDROCO\/APAP","TAB 10-325MG","3","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","28","Select","Select",""],["","00904582460","VITAMIN","TAB 1000UNIT","60","Select","Select",""],["","65162067684","AZELASTINE","SPR 0.001","30","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","5","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","31722017301","METHYLPHENID","TAB 5MG","30","Select","Select",""],["","54092038301","ADDERALL","CAP 10MG","30","Select","Select",""],["","00228305911","AMPHET\/DEXTR","CAP 10MG ER","30","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","45802010901","TRIAMCINOLON","AER 55MCG\/AC","17","Select","Select",""],["","00121072104","FLUOXETINE","SOL 20MG\/5ML","15","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","14","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","49035044301","NASAL","SPR 55MCG\/AC","17","Select","Select",""],["","50111043301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","31604004070","D3","TAB 1000UNIT","60","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","21","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":""}]}]}