{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASHLEY PETREE","gend":1,"add":"14000 STARPINE LN","city":"CHESTER","state":"VA","zip":"23836-9998","dob":"1984-01-17","age":"","mstatus":"","insh":"1419686*01","cliId":"","pno":8043576721,"cno":8043576721,"email":"","ename":"","eno":"","pphy":"BEKENSTEIN, JONATHAN W MD","ppno":8042882742,"pcpadd":"7607 FOREST AVE SUITE 300,","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23229-9998","pcpcounty":"","pcpid":"","pcpname":"Neurological Associates, Inc.","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042889053,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","Z79.899","J01.00","Z20.828","J06.9","F15.10","F31.9","NO DATA","H92.02","H69.92","G43.019","H92.01","H60.91","H73.21","F13.10","F12.90","F17.200","Z13.89","Z51.81","H90.5","I25.2","H90.A21","H61.891","H93.8X1","C44.329","C44.519","U07.1","K59.00","K13.79","R10.84","K59.09","K08.89"],"date":["2023-07-31","2023-06-12","2021-08-13","2022-01-21","2022-01-21","2022-10-18","2022-10-11","2022-10-11","2023-02-19","2023-02-19","2023-06-23","2022-11-30","2022-09-09","2022-10-14","2021-03-19","2021-03-19","2021-03-19","2021-03-19","2021-03-19","2022-11-30","2023-02-19","2022-11-30","2023-06-12","2023-06-12","2023-04-28","2023-04-28","2021-02-20","2023-08-26","2023-08-26","2023-08-26","2023-08-26","2023-08-26"],"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":[["","50111064801","FLUOXETINE CAP","20MG","30","Select","Select",""],["","00406800503","BUPREN\/NALOX SUB","2-0.5MG","28","Select","Select",""],["","43598058230","BUPREN\/NALOX MIS","8-2MG","7","Select","Select",""],["","67877024901","QUETIAPINE TAB","50MG","30","Select","Select",""],["","42858050203","BUPRENORPHIN SUB","8MG","8","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","7","Select","Select",""],["","68462053670","IMIQUIMOD CRE","5%","12","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","96439002001","RESET-O MIS IOS\/ANDR","","1","Select","Select",""],["","65862050320","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","14","Select","Select",""],["","51672411806","FLUOROURACIL","5 %","40","Select","Select",""],["","47781035703","BUPRENORPHINE-NALOXONE","8 MG-2 MG","18","Select","Select",""],["","69097081312","GABAPENTIN","100 MG","60","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","00406800503","BUPREN\/NALOX","SUB 2-0.5MG","28","Select","Select",""],["","67877024901","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","42858050203","BUPRENORPHIN","SUB 8MG","8","Select","Select",""],["","68462053670","IMIQUIMOD","CRE 0.05","12","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","96439002001","RESET-O","MIS IOS\/ANDR","1","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","59779030603","PURELAX","17 G\/DOSE","510","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":""}]}]}