{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DONNETTE JONES","gend":1,"add":"5153 LAUREL SPRINGS ROAD","city":"SPRING GROVE","state":"VA","zip":"23881-9998","dob":"1980-05-08","age":"","mstatus":"","insh":"1977548*01","cliId":"","pno":8048785747,"cno":8048785747,"email":"","ename":"","eno":"","pphy":"COLEMAN, GEORGE C MD","ppno":8048348871,"pcpadd":"344 WEST MAIN ST,","pcpcity":"WAVERLY","pcpstate":"VA","pcpzip":"23890-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048348875,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M50.021","R55.","R42.","M47.12","M48.02","G99.2","M54.12","G95.9","M54.41"],"date":["2022-01-26","2023-02-22","2023-02-22","2022-01-26","2022-01-26","2022-01-26","2022-01-26","2021-12-16","2021-12-16"],"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":[["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","70710113801","FLUCONAZOLE","TAB 100MG","1","Select","Select",""],["","68462056529","NORGEST\/ETHI","TAB ESTRADIO","28","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","65862016999","ATENOLOL","50 MG","60","Select","Select",""],["","00555901858","TRI-SPRINTEC","7DAYSX3 28","28","Select","Select",""],["","42571016242","AMOX\/K CLAV","TAB 875-125","10","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00143980305","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00781261305","AMOXICILLIN CAP","500MG","15","Select","Select",""],["","62559099212","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","68462056529","NORGEST\/ETHI TAB ESTRADIO","","28","Select","Select",""],["","65162010150","GABAPENTIN CAP","100MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP TAB","5-325MG","28","Select","Select",""],["","65862016999","ATENOLOL TAB","50MG","60","Select","Select",""],["","42571016242","AMOX\/K CLAV TAB","875-125","10","Select","Select",""],["","00555901858","TRI-SPRINTEC TAB","","84","Select","Select",""],["","65862001501","AMOXICILLIN TAB","875MG","10","Select","Select",""],["","51672128202","TRIAMCINOLON CRE","0.1%","30","Select","Select",""],["","00143980305","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","42571016242","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","68001042300","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","67877032105","IBUPROFEN","800 MG","45","Select","Select",""],["","68462056529","NORGESTIMATE-ETHINYL ESTRADIOL","7DAYSX3 28","28","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":""}]}]}