{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANAE K NORTHAM","gend":1,"add":"23 CYNTHIAS PL APT 304","city":"FREDERICKSBURG","state":"VA","zip":"22406-9998","dob":"1991-01-01","age":"","mstatus":"","insh":"1354150*01","cliId":"","pno":5409935852,"cno":5409935852,"email":"","ename":"","eno":"","pphy":"WARD, CHRISTOPHER M MD","ppno":5403474400,"pcpadd":"SUITE 202 493 BLACKWELL ROAD","pcpcity":"WARRENTON","pcpstate":"VA","pcpzip":"20186-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5403410922,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O34.32","V23.41","V23.5","Z3A.25","O99.212","E66.9","M17.0","K44.9","K21.9","E66.01","Z68.41","R11.2","O26.879","Z87.51","Z3A.26","O80.","Z37.0","Z3A.39","Z88.8","Z79.1","R87.612","Z11.3","R87.613","M25.561","M25.562","R10.13","Z09.","F41.1","Z11.1","F32.9","E55.9","E53.8","Z00.00","O60.23X0","O99.214","R07.9","R10.32","M79.605","Z72.51","N89.8","Z20.2","O34.33","Z3A.29","O99.213","Z30.430","Z30.014","Z32.02","NO DATA","R07.89","Z01.818","O47.03","Z3A.32","V23.89","Z3A.35","N30.00","E88.81"],"date":["2022-01-11","2022-02-22","2021-12-14","2021-12-15","2021-12-21","2022-02-22","2023-02-02","2023-03-16","2023-05-11","2023-05-11","2023-03-16","2023-03-16","2021-12-21","2021-12-21","2021-12-21","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-03-16","2022-05-12","2022-05-12","2022-05-12","2022-11-10","2022-11-10","2022-12-26","2022-12-26","2023-05-11","2022-05-11","2023-05-11","2023-05-11","2023-05-11","2023-05-11","2022-03-16","2022-03-16","2022-10-28","2022-10-28","2022-10-28","2022-12-12","2022-12-12","2022-12-12","2022-01-11","2022-01-11","2022-02-22","2022-06-22","2022-06-22","2022-06-22","2023-03-16","2023-02-23","2023-02-23","2022-01-28","2022-01-28","2022-02-22","2022-02-22","2022-10-28","2022-12-30"],"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":[]},{"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":[["","49035056314","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","55111064530","OMEPRAZOLE","40 MG","30","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","00548570100","MEDROXYPR AC","INJ 150MG\/ML","1","Select","Select",""],["","43547028211","ESCITALOPRAM","TAB 20MG","90","Select","Select",""],["","80681017400","VITAMIN D3","CAP 50000UNT","8","Select","Select",""],["","69315012710","FOLIC ACID","1 MG","90","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","65162047810","NITROFURANTOIN MONO-MACRO","100 MG","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":""}]}]}