{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WENDY R COMER","gend":1,"add":"117 ROUNDHEAD DR","city":"STANLEY","state":"VA","zip":"22851-9998","dob":"1983-10-02","age":"","mstatus":"","insh":"1186486*01","cliId":"","pno":5407781534,"cno":5407781534,"email":"","ename":"","eno":"","pphy":"SWITZER, DAVID MD","ppno":5408434624,"pcpadd":"STE B 250 MEMORIAL DRIVE,","pcpcity":"LURAY","pcpstate":"VA","pcpzip":"22835-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5408434626,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z31.69","J06.9","Z20.828","Z20.822","J40.","I51.7","R09.81","Z11.1","R05.9","N83.201","R10.31","E10.9","H52.13","Z01.818","G56.03","E66.01","Z68.42","I10.","Z90.49","R19.7","J39.9","E11.9","Z79.899","Z79.84","R05.8","J02.9","J02.0","M25.561","M79.641","M79.642","Z79.4"],"date":["2021-03-16","2023-02-16","2021-11-08","2023-02-16","2021-07-14","2021-07-27","2023-02-23","2023-02-01","2023-02-16","2022-06-26","2022-06-26","2021-06-29","2021-06-29","2022-11-10","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-06-26","2022-06-26","2023-01-27","2022-11-14","2022-11-14","2022-11-14","2023-02-23","2023-02-23","2023-02-23","2021-12-16","2022-11-04","2022-11-04","2022-11-10"],"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":[["","19515081852","FLULAVAL QUA INJ","2021-22","0","Select","Select",""],["","70436001002","BUPROPN HCL TAB","150MG XL","90","Select","Select",""],["","00069108530","PAXLOVID TAB","","30","Select","Select",""],["","00245003660","PREVALITE POW","4GM PK","90","Select","Select",""],["","68180098103","LISINOPRIL TAB","20MG","30","Select","Select",""],["","65862039110","ONDANSETRON TAB","8MG ODT","20","Select","Select",""],["","67877056110","METFORMIN TAB","500MG","180","Select","Select",""],["","49884012301","LABETALOL TAB","200MG","180","Select","Select",""],["","13668001105","CITALOPRAM TAB","40MG","90","Select","Select",""],["","00169406013","VICTOZA INJ","18MG\/3ML","9","Select","Select",""],["","08290320122","BD PEN NEEDL MIS","32GX4MM","100","Select","Select",""],["","16571041250","CIPROFLOXACN TAB","500MG","20","Select","Select",""],["","70710113803","FLUCONAZOLE TAB","100MG","10","Select","Select",""],["","16571020106","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","20","Select","Select",""],["","68180098103","LISINOPRIL","20 MG","30","Select","Select",""],["","00169406013","VICTOZA","3-PAK 0.6 MG\/0.1","9","Select","Select",""],["","69097012203","TOPIRAMATE","25 MG","180","Select","Select",""],["","67877056110","METFORMIN HCL","500 MG","60","Select","Select",""],["","70436001002","BUPROPION XL","150 MG","90","Select","Select",""],["","42806071505","BENZONATATE","200 MG","60","Select","Select",""],["","49884012301","LABETALOL HCL","200 MG","180","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","13668001105","CITALOPRAM HBR","40 MG","90","Select","Select",""],["","68180086111","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00093310905","AMOXICILLIN","500 MG","30","Select","Select",""],["","19515081852","FLULAVAL QUA","INJ 2021-22","0","Select","Select",""],["","00069108530","PAXLOVID","TAB ","30","Select","Select",""],["","70436001002","BUPROPN HCL","TAB 150MG XL","90","Select","Select",""],["","00245003660","PREVALITE","POW 4GM PK","90","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","20","Select","Select",""],["","67877056110","METFORMIN","TAB 500MG","180","Select","Select",""],["","49884012301","LABETALOL","TAB 200MG","180","Select","Select",""],["","13668001105","CITALOPRAM","TAB 40MG","90","Select","Select",""],["","08290320122","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","16571041250","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","70710113803","FLUCONAZOLE","TAB 100MG","10","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","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":""}]}]}