{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MELINDA J HAMMER","gend":1,"add":"110 ROSEDALE AVE STE B","city":"COVINGTON","state":"VA","zip":"24426-9998","dob":"1975-01-22","age":"","mstatus":"","insh":"1537639*01","cliId":"","pno":5409699953,"cno":5409699953,"email":"","ename":"","eno":"","pphy":"STAPLETON II, JOHN C NP","ppno":5408397197,"pcpadd":"106 PARK DR,","pcpcity":"HOT SPRINGS","pcpstate":"VA","pcpzip":"24445-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5408394831,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F39.","F43.9","F43.23","F41.1","R05.9","Z20.822","Z01.419","Z11.51","K04.7","Z79.899","L02.212","J06.9","R03.0","R11.2","R19.7","F17.200","R68.84","K08.89","L03.011","E03.9","E78.5","I10.","E11.9","J44.9","Z12.31","Z72.0","Z79.84"],"date":["2022-08-11","2022-08-11","2022-08-11","2022-08-11","2021-12-06","2022-12-13","2022-07-12","2022-07-12","2021-01-22","2021-03-23","2022-04-19","2022-12-13","2022-12-13","2022-12-13","2022-12-13","2022-12-13","2021-03-29","2021-03-29","2021-12-03","2022-04-07","2022-04-07","2022-04-07","2022-04-07","2022-04-07","2022-04-07","2022-04-07","2022-04-07"],"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":[["","65862069705","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","13668033201","TRAZODONE","TAB 150MG","30","Select","Select",""],["","00555030202","HYDROXYZ PAM","CAP 50MG","120","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","180","Select","Select",""],["","00093083205","CLONAZEPAM","0.5 MG","60","Select","Select",""],["","65862052305","GABAPENTIN","600 MG","90","Select","Select",""],["","00555077902","MEDROXYPR AC","TAB 10MG","10","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","65702071110","ACCU-CHEK","TES GUIDE","50","Select","Select",""],["","57237010099","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","00186037220","SYMBICORT","80-4.5 MCG","10.2","Select","Select",""],["","67877041401","METFORMIN","TAB 750MG ER","60","Select","Select",""],["","16729044717","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","53885099425","ONETOUCH","TES ULTRA","25","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","100","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","82607066027","FLOWFLEX","KIT TEST","8","Select","Select",""],["","59651036105","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00555077902","MEDROXYPROGESTERONE ACETATE","10 MG","10","Select","Select",""],["","00555030204","HYDROXYZINE PAMOATE","50 MG","120","Select","Select",""],["","72578003601","METFORMIN HCL ER","750 MG","60","Select","Select",""],["","00310737220","BUDESONIDE-FORMOTEROL FUMARATE","80-4.5 MCG","10.2","Select","Select",""],["","31722088390","ROSUVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","13668033201","TRAZODONE HCL","150 MG","30","Select","Select",""],["","65862069790","VENLAFAXINE HCL ER","150 MG","30","Select","Select",""],["","53885099425","ONETOUCH ULTRA TEST STRIP","","25","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","70010013905","NAPROXEN","500 MG","28","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":""}]}]}