{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LAUREN LILLISTON","gend":1,"add":"PO BOX 676","city":"ONLEY","state":"VA","zip":"23418-9998","dob":"1986-12-02","age":"","mstatus":"","insh":"1506047*01","cliId":"","pno":7577102829,"cno":7577102829,"email":"","ename":"","eno":"","pphy":"HEDSPETH, TAMMY A NP","ppno":7574426600,"pcpadd":"10085 WILLIAM F BERNART CIRCLE,","pcpcity":"NASSAWADOX","pcpstate":"VA","pcpzip":"23413-9998","pcpcounty":"","pcpid":"","pcpname":"Riverside Eastern Shore Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574423839,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E07.89","C78.1","C78.39","Z85.850","E89.0","Z92.3","Z98.890","I47.1","R00.0","R94.31","H66.90","E03.9","K21.9","K59.09","E87.6","S05.02XA","I48.91","I49.3","C73.","R07.89","R07.9","Z87.891","Z79.899","C77.0","N39.0","B96.89","R10.13","Z71.89","H66.002","H60.332","Z20.822","H66.011","R11.0","Z00.00","R06.02","I49.9"],"date":["2022-03-22","2022-03-22","2022-03-22","2022-07-15","2022-03-22","2022-03-22","2022-03-22","2022-07-16","2022-07-15","2022-04-20","2022-06-15","2021-08-18","2021-11-01","2021-11-01","2022-04-25","2023-03-04","2021-08-20","2021-08-20","2022-02-14","2022-08-25","2022-08-25","2022-08-25","2022-08-25","2021-01-22","2021-05-27","2021-05-27","2021-07-04","2021-09-02","2021-08-17","2021-08-17","2021-10-20","2022-06-20","2021-07-04","2021-09-14","2021-01-06","2022-08-27"],"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":[["","00456045901","ARMOUR THYRO","TAB 60MG","30","Select","Select",""],["","00093342501","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","42192033001","NP THYROID","TAB 60MG","30","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","61314064610","NEO\/POLY\/HC","SOL 1% OTIC","10","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","71858004504","TIROSINT","CAP 137MCG","90","Select","Select",""],["","00527496032","LEVOTHYROXIN","CAP 150MCG","30","Select","Select",""],["","16714012303","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","70000004801","ACID REDUCER","TAB 10MG","20","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","6","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00603548221","PROPRANOLOL","TAB 10MG","90","Select","Select",""],["","68382039801","POT CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","50742061510","METOPROL SUC","TAB 25MG ER","30","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","6","Select","Select",""],["","68645059459","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00527496032","LEVOTHYROXIN CAP","150MCG","30","Select","Select",""],["","42192033001","NP THYROID TAB","60MG","90","Select","Select",""],["","00603548221","PROPRANOLOL TAB","10MG","90","Select","Select",""],["","00093342501","LORAZEPAM TAB","0.5MG","30","Select","Select",""],["","68382039801","POT CHLORIDE TAB","20MEQ ER","30","Select","Select",""],["","50742061510","METOPROL SUC TAB","25MG ER","30","Select","Select",""],["","00143928501","AMOXICILLIN TAB","875MG","20","Select","Select",""],["","00456045901","ARMOUR THYRO TAB","60MG","28","Select","Select",""],["","59746017509","PREDNISONE TAB","20MG","6","Select","Select",""],["","68645059459","FAMOTIDINE TAB","20MG","60","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":""}]}]}