{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAINELLE DUFF","gend":1,"add":"523 CHINQUAPIN AVE APT 12","city":"RURAL RETREAT","state":"VA","zip":"24368-9998","dob":"1972-05-01","age":"","mstatus":"","insh":"20042620*01","cliId":"","pno":2767809255,"cno":2767809255,"email":"","ename":"","eno":"","pphy":"FP COMMUNITY SERVICES, MOUNT ROGERS FP","ppno":2762233200,"pcpadd":"770 W RIDGE RD,","pcpcity":"WYTHEVILLE","pcpstate":"VA","pcpzip":"24382-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2762230617,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S70.01XA","F15.129","W01.10XA","G47.00","F32.9","S91.302A","G62.9","F15.10","E66.9","F11.20","F17.210","F12.99","F15.93","L97.522","Z22.322","S83.91XA","M25.561","W18.39XA","Z03.89","J06.9","J30.2","L03.114","F41.9","R41.3","NO DATA","M77.42","M77.41","M20.41","M20.42","M65.872","M65.871","M92.70","H04.123","N39.0","S79.911A","R30.0","L97.909","F15.20","L03.032","G93.40","R41.82","F19.90","K80.20","V58.89","M25.552","F33.1","L84.","M79.674"],"date":["2021-02-08","2021-02-08","2021-02-08","2022-01-05","2021-09-20","2021-09-20","2021-09-20","2023-08-28","2021-02-03","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2022-03-14","2022-03-14","2022-04-18","2022-04-18","2022-04-18","2021-03-19","2021-03-19","2021-03-19","2021-07-19","2022-01-05","2022-01-05","2022-01-05","2021-02-15","2021-02-15","2022-03-14","2021-02-15","2021-02-15","2021-02-15","2021-02-15","2021-11-12","2021-05-26","2021-02-08","2021-06-16","2021-08-17","2021-08-29","2021-12-20","2023-08-25","2023-08-25","2023-08-25","2023-08-25","2021-05-25","2021-05-25","2023-09-15","2022-03-14","2022-03-14"],"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":[["","72205001690","PREGABALIN","200 MG","90","Select","Select",""],["","14539067501","HYDROXYZ PAM","CAP 50MG","120","Select","Select",""],["","13668001101","CITALOPRAM","TAB 40MG","30","Select","Select",""],["","59148003713","REXULTI","TAB 1MG","30","Select","Select",""],["","16729017501","AMITRIPTYLIN","TAB 100MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","13668022130","ARIPIPRAZOLE","30 MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","64980056210","FUROSEMIDE","20 MG","90","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","49035045875","ALLERGY REL","TAB 10MG","90","Select","Select",""],["","43547027511","DONEPEZIL","TAB 5MG","30","Select","Select",""],["","49281042150","FLUZONE QUAD","INJ 2021-22","0","Select","Select",""],["","16714045501","QUETIAPINE","TAB 200MG","360","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00002150680","MOUNJARO","2.5 MG\/0.5","2","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","13668001101","CITALOPRAM HBR","40 MG","30","Select","Select",""],["","29300042301","AMITRIPTYLINE HCL","100 MG","30","Select","Select",""],["","55111064530","OMEPRAZOLE","40 MG","90","Select","Select",""],["","00093005405","BUSPIRONE HCL","10 MG","90","Select","Select",""],["","52817033050","CYCLOBENZAPRINE HCL","5 MG","12","Select","Select",""],["","68180044801","QUETIAPINE FUMARATE","200 MG","120","Select","Select",""],["","00115180301","HYDROXYZINE PAMOATE","25 MG","45","Select","Select",""],["","43598013901","KETOROLAC TROMETHAMINE","10 MG","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":""}]}]}