{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACQUELINE M HARVEY","gend":1,"add":"3167 W 3RD ST","city":"FARMVILLE","state":"VA","zip":"23901-9998","dob":"1969-02-25","age":"","mstatus":"","insh":"20051637*01","cliId":"","pno":4344144583,"cno":4344144583,"email":"","ename":"","eno":"","pphy":"CHANDLER, SHARON L NP","ppno":4343928177,"pcpadd":"800 OAK ST,","pcpcity":"FARMVILLE","pcpstate":"VA","pcpzip":"23901-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4343928272,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F14.21","F43.10","M54.16","M17.12","J18.1","M62.81","NO DATA","Z23.","R20.8","M48.07","K81.9","Z20.822","Z11.59","K80.12","E66.01","Z68.41","E78.00","F31.9","I10.","F41.0","R73.03","N89.8","F17.210","Z86.718","Z79.01","M47.816","G89.29","Z72.0","M25.511","M79.605","M79.89","Z20.828","G25.71","S93.602A","S86.111A","Z88.2","W18.2XXA","Y92.002","Y93.89","I49.9","R07.9","R45.0","R45.7","B34.9","R09.81","F33.3","M47.812","M75.41","L30.9","Z71.89","Z71.3","E11.9","M25.562","S93.412A","Z12.12","H52.13","H52.223","H52.4","Z01.810","K92.1","K64.9","I82.409","J02.0","K80.10","R68.83"],"date":["2022-04-27","2023-06-23","2021-06-14","2021-08-10","2021-08-16","2022-05-09","2022-06-06","2021-06-08","2021-06-11","2021-06-30","2021-08-11","2023-06-09","2021-04-19","2021-08-10","2021-08-10","2021-08-10","2022-03-16","2021-08-10","2022-03-16","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2023-04-08","2021-08-10","2022-04-13","2022-02-02","2022-04-13","2022-05-24","2023-04-08","2023-04-08","2023-08-18","2021-10-12","2021-05-14","2021-05-14","2021-06-14","2021-05-14","2021-05-14","2021-05-14","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2023-05-24","2021-10-13","2023-03-27","2021-01-21","2021-01-21","2021-05-06","2021-07-13","2021-07-13","2021-10-07","2022-02-07","2021-07-13","2021-07-13","2021-10-07","2021-10-07","2021-10-07","2021-01-05","2022-03-16","2022-03-16","2022-03-16","2023-06-09","2021-08-10","2021-10-13"],"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":[["","57664037713","TRAMADOL HCL","TAB 50MG","28","Select","Select",""],["","13668022030","ARIPIPRAZOLE","20 MG","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","76204060030","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","50458057990","XARELTO","20 MG","30","Select","Select",""],["","16714008110","HYDROXYZ HCL","TAB 10MG","90","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","30","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","00713050324","ANUCORT-HC","SUP 25MG","12","Select","Select",""],["","31722053301","METHOCARBAM","TAB 500MG","60","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","27241009803","DULOXETINE HCL","30 MG","30","Select","Select",""],["","64980044801","NEOMYCIN-POLYMYXIN-HC","3.5-10K-1","10","Select","Select",""],["","16729044815","LEVOTHYROXINE SODIUM","50 MCG","30","Select","Select",""],["","23155050210","HYDROXYZINE HCL","50 MG","30","Select","Select",""],["","16571020150","DICLOFENAC SODIUM","75 MG","60","Select","Select",""],["","00172572970","FAMOTIDINE","40 MG","30","Select","Select",""],["","64764012530","NESINA","12.5 MG","30","Select","Select",""],["","65862017260","TOPIRAMATE","50 MG","30","Select","Select",""],["","59762500901","CLINDAMYCIN PHOSPHATE","2 %","40","Select","Select",""],["","69315015501","HYDROCHLOROTHIAZIDE","12.5 MG","30","Select","Select",""],["","70436015542","PROMETHAZINE-DM","6.25-15\/5","120","Select","Select",""],["","52817032000","BACLOFEN","10 MG","60","Select","Select",""],["","00378718705","METFORMIN HCL","1000 MG","60","Select","Select",""],["","00143993905","AMOXICILLIN","500 MG","40","Select","Select",""],["","50111078710","AZITHROMYCIN","250 MG","4","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","29300022705","METRONIDAZOLE","500 MG","14","Select","Select",""],["","30768017621","VITAMIN D","3 50 MCG","30","Select","Select",""],["","00006011254","JANUVIA","50 MG","30","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":""}]}]}