{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BETH  D HOLDWAY","gend":1,"add":"319 MAIN ST","city":"PENNINGTON GAP","state":"VA","zip":"24277-9998","dob":"1988-08-24","age":"","mstatus":"","insh":"20083256*01","cliId":"","pno":2763456881,"cno":2763456881,"email":"","ename":"","eno":"","pphy":"VANZEE, WAYNE","ppno":2763834428,"pcpadd":"241 MONARCH RD","pcpcity":"SAINT CHARLES","pcpstate":"VA","pcpzip":"24282-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2763834927,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G43.709","M54.81","Z98.2","G44.40","G11.9","C71.7","G43.009","C71.9","G89.4","R53.82","M62.81","R10.2","K59.03","T83.9XXA","G89.29","T40.2X5A","F31.89","F31.81","F06.4","Z91.410","N93.9","I10.","K21.9","Z30.432","G93.9","N80.9","Z30.430","Z01.812","N94.6","G31.84","H66.001","H92.01","Z59.9","R10.12","R16.1","D73.4","R40.4","Z01.810","T83.32XS","Z01.818","T83.32XA"],"date":["2023-02-16","2022-12-16","2023-02-16","2023-02-16","2023-02-16","2023-02-16","2022-10-04","2022-10-04","2023-03-22","2023-01-19","2023-03-22","2023-02-02","2023-02-02","2023-02-02","2023-02-02","2023-02-02","2022-09-29","2023-03-03","2023-03-03","2023-03-03","2023-04-03","2023-04-03","2022-12-20","2022-10-11","2022-10-04","2022-12-20","2022-12-20","2023-03-28","2023-03-28","2023-02-16","2023-03-04","2023-03-04","2022-07-01","2022-07-26","2022-07-26","2022-07-26","2022-12-16","2023-03-28","2023-03-28","2023-03-28","2023-04-03"],"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":[["","69097012412","TOPIRAMATE","100 MG","60","Select","Select",""],["","27808003703","HYDROCO\/APAP","TAB 10-325MG","120","Select","Select",""],["","00456120130","LINZESS","145 MCG","30","Select","Select",""],["","00378563259","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","65162089603","ARIPIPRAZOLE","TAB 2MG","30","Select","Select",""],["","00115166003","PROPRANOLOL","TAB 20MG","60","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00093221005","SUCRALFATE","1 G","120","Select","Select",""],["","00378623205","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","13668004701","LAMOTRIGINE","100 MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00904671772","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","67877032105","IBUPROFEN","800 MG","90","Select","Select",""],["","70000036503","STOOL SOFTNR","CAP 100MG","60","Select","Select",""],["","00555021110","NORETHIN ACE","TAB 5MG","60","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","8","Select","Select",""],["","00406052205","OXYCOD\/APAP","TAB 7.5-325","12","Select","Select",""],["","58160089052","FLUARIX QUAD","INJ 2022-23","0","Select","Select",""],["","00115166003","PROPRANOLOL HCL","20 MG","60","Select","Select",""],["","00378563259","SUMATRIPTAN SUCCINATE","100 MG","9","Select","Select",""],["","00904671772","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","00904699880","DOCUSATE SODIUM","100 MG","60","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","27808003703","HYDROCODONE-ACETAMINOPHEN","10MG-325MG","120","Select","Select",""],["","57664050988","CITALOPRAM HBR","40 MG","30","Select","Select",""],["","70000036503","STOOL SOFTENER","100 MG","60","Select","Select",""],["","65862070060","CEFUROXIME","500 MG","20","Select","Select",""],["","65862022660","CLARITHROMYCIN","500 MG","20","Select","Select",""],["","00555021110","NORETHINDRONE ACETATE","5 MG","60","Select","Select",""],["","72060012140","CAPLYTA","21 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":""}]}]}