{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SUZANNE SCHWALBE","gend":1,"add":"49 BRANSON COVE RD","city":"HAGUE","state":"VA","zip":"22469-9998","dob":"1965-10-28","age":"","mstatus":"","insh":"20034615*01","cliId":"","pno":8044722602,"cno":8044722602,"email":"","ename":"","eno":"","pphy":"WALKER, ANDREW F MD","ppno":8044939999,"pcpadd":"18849 KINGS HGHWY,","pcpcity":"MONTROSS","pcpstate":"VA","pcpzip":"22520-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.31","I10.","Z71.89","Z71.3","Z23.","M77.10","M77.12","E78.5","F31.9","J44.9","G40.909","E55.9","R05.9","R68.83","R51.9","R09.89"],"date":["2023-08-17","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2021-10-18","2022-08-12","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2023-02-15","2023-02-15","2023-02-15","2023-02-15"],"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":[["","65862049501","QUETIAPINE","TAB 400MG","75","Select","Select",""],["","13668033005","TRAZODONE","TAB 50MG","30","Select","Select",""],["","68180013601","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","75834022101","CARBAMAZEPIN","TAB 200MG","120","Select","Select",""],["","00093506201","HYDROXYZ HCL","TAB 50MG","90","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","65862049501","QUETIAPINE FUMARATE","400 MG","75","Select","Select",""],["","13668033005","TRAZODONE HCL","50 MG","30","Select","Select",""],["","00093506201","HYDROXYZINE HCL","50 MG","90","Select","Select",""],["","69097084905","ESCITALOPRAM OXALATE","20 MG","30","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","75834022101","CARBAMAZEPINE","200 MG","360","Select","Select",""],["","00378395205","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","65862049501","QUETIAPINE TAB","400MG","75","Select","Select",""],["","13668033005","TRAZODONE TAB","50MG","30","Select","Select",""],["","75834022101","CARBAMAZEPIN TAB","200MG","120","Select","Select",""],["","69097084905","ESCITALOPRAM TAB","20MG","30","Select","Select",""],["","00093506201","HYDROXYZ HCL TAB","50MG","90","Select","Select",""],["","11877001140","BINAXNOW COV KIT HOME TES","","8","Select","Select",""],["","60505258008","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","70461032203","FLUCLVX QUAD INJ","2022-23","0","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":""}]}]}