{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LILY STALLARD","gend":1,"add":"5413 OAK LN","city":"WISE","state":"VA","zip":"24293-9998","dob":"2004-10-16","age":"","mstatus":"","insh":"1582560*01","cliId":"","pno":2763281436,"cno":2763281436,"email":"","ename":"","eno":"","pphy":"MAYS, WHITNEY B NP","ppno":2763952389,"pcpadd":"515 FRONT ST W,","pcpcity":"COEBURN","pcpstate":"VA","pcpzip":"24230-9998","pcpcounty":"","pcpid":"","pcpname":"Thomas E Renfro Community Clinic","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2763956634,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J06.9","J02.9","R05.","R30.0","E10.65","R11.10","E06.3","J30.2","K90.0","F33.9","F41.1","R22.9","F41.9","J35.8","E07.9","NO DATA","E66.3","L52.","Z48.817","L30.9","L81.0","J10.89","Z20.822","E10.10","J10.1","E03.9","Z79.4","Z79.890","Z79.899","Z88.2","H10.502","E10.9","R20.2","E55.9","Z71.3","Z03.818","Z30.42","Z48.02","Z23.","S61.213A","M94.0","F32.9","J35.01","L03.90","N30.00","R73.9","L08.9","M62.838","J02.0","R05.1","Z30.012","N39.0","R31.9"],"date":["2021-05-29","2023-08-28","2021-05-29","2021-06-09","2023-08-16","2021-06-09","2022-04-27","2021-06-09","2022-04-27","2021-06-11","2022-09-07","2022-02-24","2022-11-25","2022-01-14","2022-02-08","2022-11-25","2021-12-07","2022-02-24","2022-01-31","2022-03-31","2022-03-10","2022-11-24","2022-11-25","2022-11-28","2022-11-25","2022-11-25","2023-08-16","2022-11-25","2022-11-25","2022-11-25","2021-10-01","2023-08-16","2023-06-29","2023-03-27","2023-03-27","2021-09-16","2023-07-12","2022-01-03","2021-03-31","2022-03-31","2021-06-04","2021-08-06","2022-01-14","2021-02-25","2021-06-09","2023-09-19","2022-02-08","2023-03-27","2023-08-28","2023-04-12","2023-04-14","2023-09-19","2023-09-19"],"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":[["","00527328643","LEVOTHYROXIN","TAB 125MCG","34","Select","Select",""],["","00169330312","NOVOLOG","INJ PENFILL","30","Select","Select",""],["","16729021716","SERTRALINE","TAB 100MG","30","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","30","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","08290320749","BD PEN NEEDL","MIS 32GX6MM","200","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","20","Select","Select",""],["","65862001501","AMOXICILLIN","875 MG","14","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","16714005502","MUPIROCIN","CRE 0.02","30","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","00002803101","GLUCAGON","KIT 1MG","1","Select","Select",""],["","50228043605","NAPROXEN","TAB 500MG","60","Select","Select",""],["","60758088005","FLUOROMETHOL","SUS 0.1% OP","5","Select","Select",""],["","51672125906","CLOBETASOL","OIN 0.0005","45","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","70954013510","DAPSONE","TAB 25MG","30","Select","Select",""],["","00193288050","KETOSTIX","TES STRIP","50","Select","Select",""],["","42806031250","DOXYCYCL HYC","TAB 100MG","20","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","200","Select","Select",""],["","57599000101","FREESTYLE","KIT SENSOR","2","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","10","Select","Select",""],["","63304069201","CLINDAMYCIN","CAP 150MG","28","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","2","Select","Select",""],["","00536129701","MECLIZINE","TAB 12.5MG","30","Select","Select",""],["","51862094501","NORTRIPTYLIN","CAP 10MG","90","Select","Select",""],["","68180067711","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","200","Select","Select",""],["","00172409660","BACLOFEN","10 MG","90","Select","Select",""],["","68180035309","SERTRALINE HCL","100 MG","30","Select","Select",""],["","68180097203","LEVOTHYROXINE SODIUM","137 MCG","30","Select","Select",""],["","00193288050","KETOSTIX REAGENT","","50","Select","Select",""],["","00169330312","NOVOLOG PENFILL","100\/ML","30","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","57599080000","FREESTYLE LIBRE","2 SENSOR","2","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","08290320122","ULTRA-FINE NANO PEN NEEDLE","32GX 5\/32\"","200","Select","Select",""],["","68382009101","BENZONATATE","200 MG","20","Select","Select",""],["","16729021716","SERTRALINE TAB","100MG","30","Select","Select",""],["","00193288050","KETOSTIX TES STRIP","","50","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","100","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","30","Select","Select",""],["","59746017506","PREDNISONE TAB","20MG","10","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","200","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","00169330312","NOVOLOG INJ PENFILL","","30","Select","Select",""],["","16729045317","LEVOTHYROXIN TAB","125MCG","34","Select","Select",""],["","70954013510","DAPSONE TAB","25MG","30","Select","Select",""],["","42806031250","DOXYCYCL HYC TAB","100MG","20","Select","Select",""],["","68462011944","FLUCONAZOLE TAB","150MG","3","Select","Select",""],["","63304069201","CLINDAMYCIN CAP","150MG","28","Select","Select",""],["","16714005502","MUPIROCIN CRE","2%","30","Select","Select",""],["","08290320749","BD PEN NEEDL MIS","32GX6MM","200","Select","Select",""],["","00713065615","CLOBETASOL OIN","0.05%","45","Select","Select",""],["","57599080000","FREESTY LIBR KIT","2 SENSOR","2","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","","2","Select","Select",""],["","00536129701","MECLIZINE TAB","12.5MG","30","Select","Select",""],["","51862094501","NORTRIPTYLIN CAP","10MG","90","Select","Select",""],["","00548585000","GLUCAGON KIT","1MG","1","Select","Select",""],["","65862001501","AMOXICILLIN TAB","875MG","14","Select","Select",""],["","68180067711","OSELTAMIVIR CAP","75MG","10","Select","Select",""],["","43598032675","CIPROFLOXACIN-DEXAMETHASONE","0.3 %-0.1%","7.5","Select","Select",""],["","00024586903","TOUJEO SOLOSTAR","300\/ML","4.5","Select","Select",""],["","57237004105","PENICILLIN V POTASSIUM","500 MG","40","Select","Select",""],["","65162047810","NITROFURANTOIN MONO-MACRO","100 MG","14","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":""}]}]}