{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JESSICA SHIVER","gend":1,"add":"17476 RICH VALLEY ROAD 17454 RICH VALLEY ROAD","city":"ABINGDON","state":"VA","zip":"24210-9998","dob":"1980-12-21","age":"","mstatus":"","insh":"1582145*01","cliId":"","pno":2766985865,"cno":2766985865,"email":"","ename":"","eno":"","pphy":"LEE, DANE MD","ppno":2766196128,"pcpadd":"24530 FALCON PLACE BLVD STE 102,","pcpcity":"ABINGDON","pcpstate":"VA","pcpzip":"24211-9998","pcpcounty":"","pcpid":"","pcpname":"Bhma Urgent Care Rogersville","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2766196138,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T23.332S","F15.20","J45.909","S60.221A","T24.001A","M79.89","T23.302A","Z48.00","J44.9","L03.114","F10.20","Z76.0","I10.","E11.9","S61.011A","T23.332A","F14.20","T23.002A","F17.210","Z79.899","Z79.84","M79.642","H16.143","Z72.0","R11.0","W59.11XA","L03.115","S50.11XA","S50.12XA","G89.21","M79.601","S51.811A","M79.603","V58.89","Z53.29","S50.10XA","G89.11"],"date":["2021-04-05","2022-07-22","2021-02-26","2023-06-15","2023-06-15","2023-06-15","2021-02-15","2021-02-22","2021-02-17","2021-03-12","2022-09-08","2023-02-10","2023-02-10","2023-02-10","2021-01-23","2021-04-05","2022-08-08","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2021-08-26","2023-02-10","2023-07-03","2023-07-03","2023-06-14","2023-07-07","2023-07-07","2023-07-07","2023-07-13","2023-07-13","2023-07-13","2023-07-15","2023-07-15","2023-07-07","2023-07-07"],"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":[["","60505265401","TRAZODONE TAB","100MG","30","Select","Select",""],["","65862052890","VENLAFAXINE CAP","75MG ER","30","Select","Select",""],["","00378718505","METFORMIN HCL","500 MG","60","Select","Select",""],["","68180098103","LISINOPRIL","20 MG","20","Select","Select",""],["","27808023302","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","00781185220","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","00093101042","MUPIROCIN","2 %","22","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","40","Select","Select",""],["","00378113401","KETOROLAC TROMETHAMINE","10 MG","15","Select","Select",""],["","65862018501","CLINDAMYCIN HCL","150 MG","80","Select","Select",""],["","70954006020","PREDNISONE","20 MG","5","Select","Select",""],["","00406051205","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","00781717612","NALOXONE HCL","4 MG","2","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","65862052890","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","30","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":""}]}]}