{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRAXTON E COOPER","gend":0,"add":"29301 APACHE CIR","city":"FRANKLIN","state":"VA","zip":"23851-9998","dob":"1999-12-23","age":"","mstatus":"","insh":"1054258*01","cliId":"","pno":7575626521,"cno":7575626521,"email":"","ename":"","eno":"","pphy":"KERRICK, MELISSA M NP","ppno":7575624111,"pcpadd":"1378 ARMORY DR,","pcpcity":"FRANKLIN","pcpstate":"VA","pcpzip":"23851-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours - Franklin Family  Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575623469,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R51.9","R10.9","G43.909","K58.9","E11.9","G40.909","K76.0","K21.9","E66.9","K59.00","Z79.51","Z79.899","Z79.84","Z68.28","Z79.4","Z11.59","Z20.828","H16.223","M21.41","M79.671","M21.6X1","Z01.812","Z20.822","M25.571","R47.81","G43.019","H61.23","M26.69","J30.9","J31.0","H10.013","J10.1","F51.01","G44.009","R10.10","R11.2","E11.65","I10.","K58.2","R56.9","R10.11","R14.3","R14.1","R68.81","R10.31","R10.84","NO DATA","E10.65","R43.2","Z11.52","K58.1","R79.89","E10.9","R11.0","K59.04","F41.9","Z88.0","Z88.8","H10.13","J06.9","A54.9","J30.1","R74.01","J31.2","Z91.89","Z13.220","R07.89","Z87.891"],"date":["2021-08-18","2022-07-15","2022-03-08","2023-07-12","2023-06-02","2023-03-08","2023-06-02","2023-06-02","2022-07-14","2022-03-08","2022-03-08","2022-07-15","2022-03-08","2022-07-14","2022-03-08","2021-02-24","2021-02-24","2021-04-05","2022-03-04","2022-03-04","2022-03-04","2022-03-04","2023-03-31","2022-03-04","2023-03-08","2023-03-08","2021-08-27","2021-08-27","2021-08-27","2021-08-27","2021-10-06","2022-10-07","2021-02-17","2021-08-05","2022-07-15","2023-07-12","2023-06-22","2021-11-16","2022-07-14","2022-03-08","2022-03-09","2022-03-09","2022-03-09","2022-03-09","2021-03-01","2022-07-14","2022-07-14","2022-07-14","2021-01-30","2021-01-30","2021-12-22","2021-12-22","2021-12-22","2022-03-23","2022-03-23","2023-07-12","2022-07-15","2022-07-15","2021-02-22","2023-03-31","2023-06-02","2023-06-02","2023-06-02","2023-05-30","2023-05-30","2023-05-30","2023-06-22","2023-06-22"],"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":[["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","90","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","14","Select","Select",""],["","13668033005","TRAZODONE","TAB 50MG","60","Select","Select",""],["","00006027731","JANUVIA","100 MG","30","Select","Select",""],["","24208083060","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","00591079401","DICYCLOMINE","CAP 10MG","10","Select","Select",""],["","00591046105","GLIPIZIDE","10 MG","60","Select","Select",""],["","16729011917","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","65162011510","HYDROCO\/APAP","TAB 7.5-325","28","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","12","Select","Select",""],["","43547035211","LISINOPRIL","5 MG","90","Select","Select",""],["","00054029399","AZELASTINE","SPR 0.001","30","Select","Select",""],["","24208039830","IPRATROPIUM","SPR 0.0003","30","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","12","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00093506001","HYDROXYZ HCL","TAB 10MG","30","Select","Select",""],["","13709023001","CLEARCANAL","DRO 0.065","15","Select","Select",""],["","42037010478","DEBROX","SOL 6.5% OT","15","Select","Select",""],["","16729017217","AMITRIPTYLINE HCL","25 MG","90","Select","Select",""],["","68382080610","TRAZODONE HCL","100 MG","90","Select","Select",""],["","00093506001","HYDROXYZINE HCL","10 MG","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","62756052188","SUMATRIPTAN SUCCINATE","50 MG","10","Select","Select",""],["","31722072610","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","13668033105","TRAZODONE TAB","100MG","30","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","70700015010","OMEPRAZOLE CAP","20MG","180","Select","Select",""],["","00006027731","JANUVIA TAB","100MG","30","Select","Select",""],["","50383070016","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","16729011917","MONTELUKAST TAB","10MG","90","Select","Select",""],["","43547035211","LISINOPRIL TAB","5MG","90","Select","Select",""],["","62559031610","GLIPIZIDE TAB","10MG","60","Select","Select",""],["","00093506001","HYDROXYZ HCL TAB","10MG","30","Select","Select",""],["","42037010478","DEBROX SOL","6.5% OT","15","Select","Select",""],["","65862018730","ONDANSETRON TAB","4MG","20","Select","Select",""],["","13709023001","CLEARCANAL DRO","6.5%","15","Select","Select",""],["","51224012230","AZITHROMYCIN","500 MG","5","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":""}]}]}