{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIERA L HUCKABY","gend":1,"add":"5226 NATURAL TUNNEL PKWY","city":"DUFFIELD","state":"VA","zip":"24244-9998","dob":"2005-03-14","age":"","mstatus":"","insh":"1726734*01","cliId":"","pno":2763656770,"cno":2763656770,"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":["F33.2","R25.9","F44.9","F33.9","R53.83","F41.9","K90.0","Z23.","L70.0","Z79.899","K13.0","R00.1","T50.905A","I47.1","R42.","R26.9","R55.","R44.3","R25.1","N76.0","Z20.2","Z72.51","B37.9","T36.95XA","L85.3","R68.89","J06.9","R29.898","R51.9","R30.0","B96.89","R04.0","Z00.129","R00.2","I49.8","R44.1","Z20.822","Z11.1","R74.8","A08.4"],"date":["2021-12-06","2021-11-08","2022-02-09","2021-12-07","2021-11-08","2022-02-09","2021-12-07","2023-08-31","2022-11-16","2022-11-16","2022-11-16","2021-05-27","2021-05-23","2022-11-30","2021-08-30","2022-01-11","2021-10-29","2021-10-29","2021-08-30","2022-06-10","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-11-16","2022-11-21","2022-11-21","2021-09-01","2021-09-01","2022-06-10","2022-06-10","2022-06-14","2022-08-19","2023-05-13","2023-05-13","2021-08-28","2021-08-28","2022-10-03","2021-10-08","2023-04-14"],"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":[["","53746027205","SMZ\/TMP DS","TAB 800-160","60","Select","Select",""],["","68382011405","RISPERIDONE","TAB 1MG","30","Select","Select",""],["","00093506110","HYDROXYZ HCL","TAB 25MG","90","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00378661493","AMNESTEEM","CAP 40MG","30","Select","Select",""],["","00245057501","ISOTRETINOIN","CAP 40MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","58160095509","MENVEO","INJ ","1","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","49281042250","FLUZONE QUAD","INJ 2022-23","0","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","20","Select","Select",""],["","68462015713","ONDANSETRON ODT","4 MG","360","Select","Select",""],["","62559038001","FLECAINIDE ACETATE","50 MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","30","Select","Select",""],["","00591544210","PREDNISONE","10 MG","15","Select","Select",""],["","53746027205","SMZ\/TMP DS TAB","800-160","60","Select","Select",""],["","65862037401","ESCITALOPRAM TAB","10MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","68382011405","RISPERIDONE TAB","1MG","30","Select","Select",""],["","00093506110","HYDROXYZ HCL TAB","25MG","90","Select","Select",""],["","00378661493","AMNESTEEM CAP","40MG","30","Select","Select",""],["","00245057501","ISOTRETINOIN CAP","40MG","30","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","58160095509","MENVEO INJ","","1","Select","Select",""],["","70461032203","FLUCLVX QUAD INJ","2022-23","0","Select","Select",""],["","42806071501","BENZONATATE CAP","200MG","20","Select","Select",""],["","49281042250","FLUZONE QUAD INJ","2022-23","0","Select","Select",""],["","80777027310","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","66993037083","MEDROXYPROGESTERONE ACETATE","150 MG\/ML","1","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":""}]}]}