{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CASSANDRA   C AYERSMAN","gend":1,"add":"PO BOX 226","city":"DELTAVILLE","state":"VA","zip":"23043-9998","dob":"1987-05-22","age":"","mstatus":"","insh":"1193898*01","cliId":"","pno":8048245629,"cno":8048245629,"email":"","ename":"","eno":"","pphy":"WOLF-SMALL, BRIGITTE MD","ppno":8047769221,"pcpadd":"9891 GENERAL PULLER HWY","pcpcity":"HARTFIELD","pcpstate":"VA","pcpzip":"23071-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours Lively Medical Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047767537,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F43.23","F33.1","F41.1","F90.9","Z72.0","F40.10","G47.00","K59.03","G47.50","E10.9","E78.5","Z68.30"],"date":["2023-03-20","2022-02-07","2023-03-20","2023-03-20","2023-03-20","2023-03-20","2023-03-13","2022-01-26","2022-11-03","2023-02-13","2022-03-03","2022-03-03","2021-06-21"],"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":[["","00088222033","LANTUS","100\/ML","10","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","7","Select","Select",""],["","12496120203","SUBOXONE","MIS 2-0.5MG","45","Select","Select",""],["","00002751001","HUMALOG","INJ 100\/ML","10","Select","Select",""],["","49502019580","SEMGLEE","SOL 100U\/ML","10","Select","Select",""],["","08290328468","INSULIN SYRG","MIS 0.5\/31G","100","Select","Select",""],["","00904672559","SENNA","TAB 8.6MG","60","Select","Select",""],["","00115166101","PROPRANOLOL","TAB 40MG","8","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","23155050101","HYDROXYZ HCL","TAB 25MG","60","Select","Select",""],["","13107003134","MIRTAZAPINE","TAB 15MG","8","Select","Select",""],["","00536589588","NICOTINE TD","DIS 14MG\/24H","28","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","68462026290","ROSUVASTATIN","TAB 10MG","30","Select","Select",""],["","57896045401","GERI-KOT","TAB 8.6MG","60","Select","Select",""],["","65862019201","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","50111056002","TRAZODONE","TAB 50MG","30","Select","Select",""],["","68462027030","ATOMOXETINE","CAP 80MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","57841130001","MOVANTIK","TAB 12.5MG","30","Select","Select",""],["","12496010001","SUBLOCADE","100 MG\/0.5","0.5","Select","Select",""],["","50458058801","CONCERTA","27 MG","30","Select","Select",""],["","31722095301","METHYLPHENID","TAB 27MG ER","30","Select","Select",""],["","68382013814","TOPIRAMATE","TAB 25MG","30","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","00002773701","INSULIN LISP","INJ 100\/ML","10","Select","Select",""],["","31722095301","METHYLPHENIDATE ER","27 MG","30","Select","Select",""],["","68180067106","LURASIDONE HCL","40 MG","30","Select","Select",""],["","08290328468","INSULIN SYRINGE","31 GX5\/16\"","100","Select","Select",""],["","49502039380","INSULIN GLARGINE-YFGN","100\/ML","10","Select","Select",""],["","65862019201","FLUOXETINE HCL","10 MG","30","Select","Select",""],["","23155050110","HYDROXYZINE HCL","25 MG","60","Select","Select",""],["","00002773701","INSULIN LISPRO","100\/ML","10","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":""}]}]}