{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALICIA VINCENT","gend":1,"add":"6330 DARLINGTON HEIGHTS RD APT A","city":"FARMVILLE","state":"VA","zip":"23901-9998","dob":"1982-10-20","age":"","mstatus":"","insh":"1798682*01","cliId":"","pno":4092021918,"cno":4092021918,"email":"","ename":"","eno":"","pphy":"KIDD, KRISTI MD","ppno":4343858942,"pcpadd":"2007 GRAVES MILL RD,","pcpcity":"FOREST","pcpstate":"VA","pcpzip":"24551-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4343855947,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.32","O20.0","Z3A.01","O02.1","Z01.419","Z30.9","Z30.09","O03.9","T23.172A","M51.9","S70.12XA","S30.0XXA","Z30.46","S61.242A","S69.91XA","S60.450A","W45.8XXA","M51.36","M54.5","M43.16","M54.16","L30.9","Z87.891","M25.551","M25.561","NO DATA","Z23.","M54.9","S16.1XXA"],"date":["2022-11-07","2021-04-18","2021-04-18","2021-04-21","2021-08-20","2021-08-20","2023-04-11","2021-05-03","2021-12-03","2022-02-23","2022-02-23","2022-02-23","2021-01-21","2022-06-30","2022-06-30","2022-06-30","2022-06-30","2021-04-09","2021-04-09","2021-04-09","2021-04-09","2022-02-14","2022-06-30","2022-08-02","2022-08-02","2022-08-02","2021-12-03","2022-01-19","2022-01-19"],"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":[["","65862022701","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","180","Select","Select",""],["","68462073129","HAILEY 24","TAB FE","28","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","68180086473","BLISOVI 24","TAB FE 1\/20","28","Select","Select",""],["","00430053014","LOESTRIN 24","TAB FE","28","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","45802026337","CLINDAMYCIN","MIS 0.01","60","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","10702001801","OXYCODONE HCL","5 MG","5","Select","Select",""],["","68462073129","HAILEY","24 TAB FE","28","Select","Select",""],["","63402030230","LATUDA TAB","20MG","30","Select","Select",""],["","68180086473","BLISOVI","24 TAB FE 1\/20","28","Select","Select",""],["","00430053014","LOESTRIN","24 TAB FE","28","Select","Select",""],["","65862022701","LAMOTRIGINE TAB","25MG","60","Select","Select",""],["","16571020106","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","60505025103","TIZANIDINE TAB","2MG","180","Select","Select",""],["","45802026337","CLINDAMYCIN MIS","1%","60","Select","Select",""],["","00093342210","CYCLOBENZAPR TAB","10MG","20","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","20","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":""}]}]}