{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JOHN W BROWN","gend":0,"add":"3358 ZACHARY TAYLOR HWY","city":"CULPEPER","state":"VA","zip":"22701-9998","dob":"1967-12-10","age":"","mstatus":"","insh":"20063986*01","cliId":"","pno":5407188817,"cno":5407188817,"email":"","ename":"","eno":"","pphy":"JENKINS, SARAH PA","ppno":8047769221,"pcpadd":"9891 GENERAL PULLER HWY,","pcpcity":"HARTFIELD","pcpstate":"VA","pcpzip":"23071-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours Lively Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8047767537,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J43.9","Z99.81","I10.","E78.00","Z12.11","Z68.25","M62.838","R25.2","J44.9","J84.10","F17.200","E87.5","Z79.51","J96.01","J21.9","J30.2","J20.9","E78.5","F17.210","Z79.899","Z20.822","J44.1","R06.09","M54.5","M54.31","M51.36","M51.26","Z23.","Z11.59","R21.","L21.9","Z68.24","J96.11","J30.1","R06.89","R07.9","I70.0","J93.12","Z09.","I25.10","F41.8","L98.9","L28.1","L82.1","L85.3"],"date":["2023-05-08","2022-05-15","2023-05-08","2022-05-15","2021-03-22","2021-03-22","2022-02-28","2022-02-28","2023-07-30","2022-02-28","2022-04-11","2022-02-28","2022-07-15","2022-05-15","2022-05-17","2022-05-16","2022-05-17","2023-05-08","2022-12-07","2022-07-15","2022-05-15","2022-12-07","2023-07-30","2021-05-11","2021-08-04","2021-05-13","2021-08-04","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2022-07-19","2021-04-14","2022-05-15","2022-05-15","2022-06-03","2022-04-11","2022-05-23","2022-06-03","2021-05-13","2021-05-13","2022-01-20","2022-01-20","2022-01-20"],"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":[["","67877051210","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","57237010099","METOPROL TAR","TAB 25MG","28","Select","Select",""],["","00173089310","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","67877019805","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","12","Select","Select",""],["","16729021616","SERTRALINE","TAB 50MG","30","Select","Select",""],["","68462019005","NAPROXEN","500 MG","60","Select","Select",""],["","00832105410","BACLOFEN","TAB 10MG","60","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","00173087310","INCRUSE ELPT","INH 62.5MCG","30","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","00054074287","ALBUTEROL","AER HFA","7","Select","Select",""],["","47335075649","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","69842080601","CVS MUCUS ER","TAB 600MG","30","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","18","Select","Select",""],["","33342002332","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","53489011905","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","00173089310","TRELEGY ELLIPTA","200-62.5","60","Select","Select",""],["","67877019805","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","00054074287","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","67877051210","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","68180035202","SERTRALINE HCL","50 MG","30","Select","Select",""],["","72888000400","METOPROLOL TARTRATE","25 MG","90","Select","Select",""],["","00173089310","TRELEGY AER ELLIPTA","","60","Select","Select",""],["","68462019005","NAPROXEN TAB","500MG","60","Select","Select",""],["","57237010099","METOPROL TAR TAB","25MG","28","Select","Select",""],["","67877051210","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","16729021616","SERTRALINE TAB","50MG","30","Select","Select",""],["","67877019805","AMLODIPINE TAB","5MG","30","Select","Select",""],["","00603533715","PREDNISONE PAK","5MG","21","Select","Select",""],["","33342002332","LEVOFLOXACIN TAB","750MG","5","Select","Select",""],["","69842080601","CVS MUCUS ER TAB","600MG","30","Select","Select",""],["","47335075649","IPRATROPIUM\/ SOL ALBUTER","","90","Select","Select",""],["","00378827052","ALBUTEROL NEB","0.083%","150","Select","Select",""],["","00054074287","ALBUTEROL AER HFA","","7","Select","Select",""],["","00378064205","PREDNISONE TAB","20MG","18","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00173089310","TRELEGY AER","200MCG","60","Select","Select",""],["","53489011905","DOXYCYCL HYC CAP","100MG","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":""}]}]}