{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NICOLE R VAUGHAN","gend":1,"add":"12859 JERUSALEM PLANK ROAD","city":"WAVERLY","state":"VA","zip":"23890-9998","dob":"1983-07-30","age":"","mstatus":"","insh":"20035850*01","cliId":"","pno":8046510170,"cno":8046510170,"email":"","ename":"","eno":"","pphy":"BUSH, JAMES A MD","ppno":8044588557,"pcpadd":"815 W POYTHRESS ST,","pcpcity":"HOPEWELL","pcpstate":"VA","pcpzip":"23860-9998","pcpcounty":"","pcpid":"","pcpname":"Appomattox River Primary Care, LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8045417113,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F25.0","U07.1","J18.9","Z72.0","R00.0","R06.02","F29.","E66.9","F25.9","K29.50","F31.9","F20.9","Z01.419","Z11.3","Z11.51","N94.6","N93.8","Z68.28","K22.2","Z68.32","R41.82","F60.0","K21.00","K21.9","R11.2","D72.829","E66.3","F20.0","F32.9","F41.9","Z91.19","V62.85","F23.","F22.","F17.200","Z03.818","Z91.14","F17.210","E66.01","R46.2","R51.9","R53.1","R07.9","R69.","R12.","R11.10","R19.7","R94.4","M79.662","M79.661","Z79.899","R50.9","N17.9","V62.84","E86.0","F43.10","F41.1","Z86.59","R45.4","Z20.822","R03.0","L20.9","K02.9","K08.89"],"date":["2023-08-31","2021-09-05","2021-08-06","2021-08-06","2022-07-11","2021-09-05","2022-07-09","2022-07-09","2023-04-06","2021-04-05","2023-03-21","2023-08-14","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2022-03-17","2021-08-11","2021-12-08","2022-03-17","2022-07-08","2021-07-19","2021-08-11","2023-04-15","2021-08-29","2021-01-21","2023-08-12","2021-08-30","2023-03-24","2021-11-27","2022-07-08","2022-07-08","2022-07-08","2022-07-08","2022-07-08","2023-03-24","2023-03-24","2022-07-11","2021-01-17","2023-02-05","2021-10-14","2021-10-14","2022-10-19","2021-06-03","2023-04-15","2021-06-03","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-29","2021-08-28","2023-03-24","2021-08-28","2021-11-28","2021-11-28","2021-11-28","2022-07-08","2023-04-15","2023-03-24","2023-03-24","2023-09-14","2023-09-14"],"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":[["","50428027709","CVS NICOTINE","LOZ 2MG","96","Select","Select",""],["","65862049101","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","00093321205","CLONAZEPAM","1 MG","30","Select","Select",""],["","00832155011","HALOPERIDOL","10 MG","30","Select","Select",""],["","69315013601","BENZTROPINE","TAB 0.5MG","60","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","63323046901","HALOPER DEC","INJ 50MG\/ML","1","Select","Select",""],["","16729028912","BUSPIRONE","TAB 30MG","60","Select","Select",""],["","13668000905","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","30","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","23155019101","BUPROPION","TAB 75MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","55111029336","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","50428317861","CVS ANTACID","SUS ANTIGAS","355","Select","Select",""],["","62856024330","ACIPHEX","TAB 20MG","30","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","180","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","60","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","42806016105","HYDROXYZ HCL","TAB 50MG","60","Select","Select",""],["","43975035003","PALIPERIDONE","TAB ER 3MG","30","Select","Select",""],["","10702002501","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","00904530760","BANOPHEN","50 MG","30","Select","Select",""],["","29300014901","QUETIAPINE FUMARATE","100 MG","30","Select","Select",""],["","50428047392","ALLERGY","25 MG","10","Select","Select",""],["","50428050854","PURELAX","17 G","3","Select","Select",""],["","00093310905","AMOXICILLIN","500 MG","21","Select","Select",""],["","59779019006","NICOTINE LOZENGE","4 MG","96","Select","Select",""],["","49483060350","IBUPROFEN","600 MG","56","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":""}]}]}