{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LARRY JUSTICE","gend":0,"add":"4503 OLD GUESSES FORK ROAD","city":"HURLEY","state":"VA","zip":"24620-9998","dob":"1992-12-15","age":"","mstatus":"","insh":"1988201*01","cliId":"","pno":2762494720,"cno":2762494720,"email":"","ename":"","eno":"","pphy":"SELLERS-MOONEY, DEBORAH C NP","ppno":2764159600,"pcpadd":"754 E MAIN ST","pcpcity":"LEBANON","pcpstate":"VA","pcpzip":"24266-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8899099643,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F41.9","F32.9","F15.20","E29.1","N52.39","G62.9","L03.114","F33.1","A49.02","L03.90","E55.9","R53.82","E03.9","E53.8","F15.21","J32.9","T78.49XS","R79.89","J00."],"date":["2023-03-28","2023-03-28","2022-12-27","2022-06-14","2023-03-28","2022-10-04","2021-03-23","2021-06-05","2021-11-02","2023-02-14","2021-09-14","2022-10-18","2021-07-27","2021-06-15","2021-06-15","2021-01-12","2021-01-12","2021-01-12","2021-06-22","2021-06-22"],"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":[["","68462012605","GABAPENTIN","TAB 600MG","21","Select","Select",""],["","12496120801","SUBOXONE","MIS 8-2MG","14","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","56","Select","Select",""],["","59762372104","ALPRAZOLAM","1 MG","84","Select","Select",""],["","13107006101","PHENTERMINE","TAB 37.5MG","56","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68180032006","BUPROPN HCL","TAB 300MG XL","30","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","16729020216","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","64380073706","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","70069000510","CYANOCOBALAM","INJ 1000MCG","3","Select","Select",""],["","69238183007","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","00143980305","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","41167431002","ALLEGRA-D","TAB 12 HOUR","60","Select","Select",""],["","00135057602","FLONASE ALGY","SPR 50MCG","10","Select","Select",""],["","14428000003","BACITRAYCIN","OIN 500\/GM","28","Select","Select",""],["","51645091301","VITAMIN B-12","TAB 500MCG","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","42","Select","Select",""],["","00234057508","HIBICLENS","4 %","237","Select","Select",""],["","00574082010","TESTOST CYP","INJ 200MG\/ML","10","Select","Select",""],["","70000040701","ANTISEPTIC","SOL 0.04","237","Select","Select",""],["","16729003510","ANASTROZOLE","TAB 1MG","8","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","08290309570","3ML LL SYRNG","MIS 25GX5\/8\"","4","Select","Select",""],["","00185041505","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","08290305781","SYRG\/NDL 3ML","MIS 25GX5\/8\"","4","Select","Select",""],["","45802011222","MUPIROCIN","2 %","22","Select","Select",""],["","08290305781","3ML SYRINGE","MIS 25GX5\/8\"","10","Select","Select",""],["","65162027210","SMZ\/TMP DS","TAB 800-160","28","Select","Select",""],["","70000040701","ANTISEPTIC SKIN CLEANSER","4 %","236","Select","Select",""],["","00143980305","DOXYCYCLINE HYCLATE","100 MG","60","Select","Select",""],["","00781307471","TESTOSTERONE CYPIONATE","200 MG\/ML","4","Select","Select",""],["","65162041503","BUPRENORPHINE-NALOXONE","8 MG-2 MG","56","Select","Select",""],["","13703010162","SYRINGE WITH NEEDLE DISP","25GX1\"","10","Select","Select",""],["","91237000108","EASY COMFORT INSULIN SYRINGE","30 GX5\/16\"","10","Select","Select",""],["","65162027250","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","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":""}]}]}