{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBECCA FUGATE","gend":1,"add":"841 PORTSMOUTH AVE","city":"BRISTOL","state":"VA","zip":"24201-9998","dob":"1964-08-08","age":"","mstatus":"","insh":"1612407*01","cliId":"","pno":2764941762,"cno":2764941762,"email":"","ename":"","eno":"","pphy":"FRENCH, ANDREW T DO","ppno":4239902400,"pcpadd":"240 MEDICAL PARK BLVD STE 3000","pcpcity":"BRISTOL","pcpstate":"TN","pcpzip":"37620-9998","pcpcounty":"","pcpid":"","pcpname":"Holston Medical Group PC","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4239902405,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.5","R26.89","B37.0","M46.46","S32.000A","F15.10","V54.29","M84.48XD","M48.062","M46.26","S32.040A","Z79.2","V54.17","I10.","F17.210","Z45.2","Z51.81","Z79.82","M86.8X8","M84.48XA","S32.040D","NO DATA","G89.29","R26.9","M48.56XA","E87.2","F41.9","F19.90","Z91.19","Z22.322","B18.2","R13.14","D50.9","F19.10","Z71.89","B37.2","S32.029A","S32.039A","M86.10","F19.20","D64.9","R11.0","R13.10","M25.551","F11.99","F32.9","J44.9","Q60.0","F19.11","R60.0","F31.81","M47.816","M62.838","Z20.822","Z86.14","F17.200","Z53.29","M46.40","M54.9","M46.20","M25.571","R06.02","R93.2"],"date":["2021-08-31","2021-03-04","2021-03-04","2023-04-27","2021-06-03","2021-08-17","2021-10-11","2021-07-15","2021-07-15","2021-12-07","2021-12-07","2021-12-07","2021-08-17","2023-04-27","2023-04-27","2021-08-17","2021-08-17","2021-08-17","2021-04-29","2021-05-01","2021-06-30","2023-04-27","2023-04-27","2021-12-01","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-04-30","2021-05-04","2023-04-27","2023-01-18","2023-01-18","2021-03-26","2021-03-26","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-06-03","2021-12-07","2023-02-15","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2023-04-27","2021-07-14","2022-09-12","2023-04-27","2023-04-27","2022-09-12","2022-01-30","2021-03-19","2021-03-19","2021-02-25","2021-04-30","2021-04-30","2021-04-30","2023-04-27","2023-04-27","2023-04-27"],"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":[["","68382009810","PAROXETINE","TAB 20MG","30","Select","Select",""],["","43547035311","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","00093005401","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","00054017713","BUPRENORPHIN","SUB 8MG","36","Select","Select",""],["","00527133001","BACLOFEN","TAB 10MG","60","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00603533715","PREDNISONE","5 MG","21","Select","Select",""],["","00121086800","NYSTATIN","SUS 100000","200","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","4","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","67919004102","SIVEXTRO","TAB 200MG","30","Select","Select",""],["","00143980305","DOXYCYCL HYC","CAP 100MG","60","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","90","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","14","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","60","Select","Select",""],["","29300012410","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","69315090405","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","18","Select","Select",""],["","64980029410","SODIUM BICAR","TAB 10GR","60","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","180","Select","Select",""],["","00378001805","METOPROL TAR","TAB 25MG","20","Select","Select",""],["","49483060201","IBUPROFEN","400 MG","60","Select","Select",""],["","67877022310","GABAPENTIN","300 MG","42","Select","Select",""],["","40985027288","VITAMIN D3","TAB 5000UNIT","30","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","300","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","51660052653","ALLERGY RELF","TAB 10MG","10","Select","Select",""],["","00172392770","DIAZEPAM","TAB 10MG","1","Select","Select",""],["","57664085385","MINOCYCLINE","CAP 100MG","60","Select","Select",""],["","67877024210","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","90","Select","Select",""],["","00054429725","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","65862019105","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","00054017713","BUPRENORPHINE HCL","8 MG","42","Select","Select",""],["","65862018730","ONDANSETRON HCL","4 MG","60","Select","Select",""],["","13668048450","MINOCYCLINE HCL","100 MG","60","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","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":""}]}]}