{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRIANNA BORRELL","gend":1,"add":"PO BOX 83","city":"MONTEREY","state":"VA","zip":"24465-9998","dob":"2004-10-18","age":"","mstatus":"","insh":"9662936*01","cliId":"","pno":"540\/396-4728","cno":"","email":"","ename":"","eno":"","pphy":"WEBB, TAYLOR DICKINSON FNP","ppno":"540\/468-6400","pcpadd":"120 JACKSON RIVER RD","pcpcity":"MONTEREY","pcpstate":"VA","pcpzip":24465,"pcpcounty":"","pcpid":"","pcpname":"HIGHLAND MEDICAL CENTER INC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"540\/468-3301","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.129","J45.998","Z30.41","Z01.419","Z02.5","K21.9","T50.905A","R63.5","Z30.9","J45.909","B09.","Z70.8","M54.2","S61.211A","W26.0XXA","Y93.G3","U07.1","R11.2","T22.299A"],"date":["2020-12-02","2020-12-02","2020-12-02","2020-06-19","2021-10-27","2021-10-27","2019-01-23","2019-07-23","2019-01-08","2019-04-10","2019-04-10","2019-04-10","2019-04-15","2019-07-22","2019-07-22","2019-07-22","2022-01-21","2022-01-21","2022-06-30"],"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":[["","70700015010","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00054028913","MONTELUKAST","CHW 5MG","30","Select","Select",""],["","00378363705","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00093614882","CAMRESE","TAB ","91","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","00713028031","BACITRACIN","OIN 500\/GM","85","Select","Select",""],["","65162046550","IBUPROFEN","TAB 600MG","15","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","3","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00378728490","LEVONOR\/ETHI","TAB ESTRADIO","91","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00781635587","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","69097085507","NAPROXEN","TAB 500MG","60","Select","Select",""],["","73796069940","PEAK","MIS ADLT\/PED","1","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","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":""}]}]}