{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHANIE L CUBBAGE","gend":1,"add":"815 JUDY LN","city":"STANLEY","state":"VA","zip":"22851-9998","dob":"1982-06-15","age":"","mstatus":"","insh":"1204148*01","cliId":"","pno":5407783048,"cno":5407783048,"email":"","ename":"","eno":"","pphy":"LEE, R DAVID MD","ppno":5407432887,"pcpadd":"135 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":5407431288,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.828","R06.02","R11.2","R19.7","F11.20","F41.1","F15.90","K59.00","J20.9","H66.93","Z20.822","R50.81","R05.9","R06.2","R50.9","R05.","B34.9","Z28.9","F41.9","F19.10","F33.9","K59.03","H66.001","H35.33","H47.323","Z02.89","H52.13"],"date":["2021-08-22","2021-08-22","2021-08-22","2021-08-22","2023-09-14","2023-09-06","2023-09-14","2023-06-29","2022-10-20","2022-10-20","2022-10-20","2022-10-20","2022-10-20","2022-10-20","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-12-13","2021-11-05","2021-11-05","2023-03-23","2021-12-13","2022-05-04","2022-05-04","2022-05-04","2022-05-04"],"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":[["","13668001990","VENLAFAXINE","CAP 75MG ER","90","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","15","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","90","Select","Select",""],["","68645052254","SERTRALINE","TAB 50MG","30","Select","Select",""],["","16714029904","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","42","Select","Select",""],["","68180044701","QUETIAPINE","TAB 100MG","90","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","300","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","14","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","15","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","12","Select","Select",""],["","29300046801","CLONIDINE","TAB 0.1MG","10","Select","Select",""],["","16571086350","BUPROPION XL","300 MG","30","Select","Select",""],["","60505024801","MIRTAZAPINE","30 MG","30","Select","Select",""],["","00456120130","LINZESS","145 MCG","30","Select","Select",""],["","00093342501","LORAZEPAM","0.5 MG","30","Select","Select",""],["","49035030603","CLEARLAX","17 G\/DOSE","1020","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":""}]}]}