{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MYA WEBSTER","gend":1,"add":"764 BELLE CT APT 333","city":"CULPEPER","state":"VA","zip":"22701-9998","dob":"1999-03-02","age":"","mstatus":"","insh":"2123314*01","cliId":"","pno":5408125510,"cno":5408125510,"email":"","ename":"","eno":"","pphy":"KUCIA, MATTHEW R MD","ppno":5403213002,"pcpadd":"633 SUNSET LN STE A,","pcpcity":"CULPEPER","pcpstate":"VA","pcpzip":"22701-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5408290019,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z34.83","Z3A.28","O98.32","A63.0","A56.8","Z3A.38","Z37.0","Z87.891","O69.81X0","Z33.1","Z3A.10","Z87.42","R10.2","F11.20","O21.9","Z36.87","Z11.4","Z3A.11","O36.5930","Z3A.35","Z30.430","O36.8330","Z3A.36","N39.0","Z11.3","Z32.02","O26.893","N89.8","O98.813","A74.9","Z3A.37","A64.","O99.323","Z86.19","Z3A.32","O99.334","F17.210","O80.","Z39.1","Z34.82","R87.610","R87.619","Z30.014","O36.5990","O26.13","Z3A.34","O99.324","F11.90","R60.9","V23.9","Z3A.39","A54.9","Z3A.27","O98.212","O98.312","O99.322","O99.512","J45.909","NO DATA","R32.","V58.89","S32.10XS","V54.17","I26.99","S22.009A","V09.20XD","S40.812A","S32.10XA","S32.059A","S22.060A","S22.030A","S22.010A","S22.020A","V87.7XXA","I82.432","I82.442","S22.019A","S22.029A","S22.039A","S22.059A","S22.069A","F14.90","F12.90","Z56.0","V09.20XA"],"date":["2022-05-17","2021-01-20","2022-04-29","2022-04-29","2021-04-01","2021-04-02","2022-04-29","2021-04-01","2021-04-02","2021-12-07","2021-10-11","2022-03-29","2022-05-17","2022-09-12","2022-03-29","2021-11-04","2021-11-04","2021-11-04","2022-04-29","2022-04-15","2022-09-07","2022-04-29","2022-04-26","2023-01-30","2023-01-30","2023-01-30","2021-03-22","2022-08-17","2021-03-22","2022-02-24","2022-04-29","2021-11-10","2022-04-29","2022-03-29","2022-03-29","2022-04-29","2022-04-29","2022-04-29","2022-05-17","2022-05-17","2022-08-17","2022-08-17","2022-08-17","2022-04-13","2022-04-13","2022-04-13","2022-04-29","2022-04-29","2022-05-17","2022-04-26","2022-04-29","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2022-02-24","2023-08-09","2022-05-20","2023-08-09","2023-08-09","2023-08-09","2023-08-09","2023-08-09","2023-08-09","2023-08-06","2023-08-06","2023-08-06","2023-08-06","2023-08-06","2023-08-06","2023-08-06","2023-08-06","2023-08-09","2023-08-09","2023-08-06","2023-08-06","2023-08-06","2023-08-06","2023-08-06","2023-08-06","2023-08-06","2023-08-06","2023-08-06"],"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":[["","80777027310","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","58160084211","BOOSTRIX INJ","","0","Select","Select",""],["","59267102501","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","59651036205","IBUPROFEN TAB","800MG","30","Select","Select",""],["","50111033301","METRONIDAZOL TAB","250MG","28","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","2","Select","Select",""],["","50111033402","METRONIDAZOLE","500 MG","14","Select","Select",""],["","23155013525","DOXYCYCLINE MONOHYDRATE","100 MG","14","Select","Select",""],["","00093314705","CEPHALEXIN","500 MG","14","Select","Select",""],["","58160084211","BOOSTRIX","INJ ","0","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","59267102501","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","59651036205","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","50111033301","METRONIDAZOL","TAB 250MG","28","Select","Select",""],["","49483034010","ACETAMINOPHEN","325 MG","30","Select","Select",""],["","76385012350","METHOCARBAMOL","500 MG","30","Select","Select",""],["","49483008010","SENNA","8.6 MG","5","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","10702001801","OXYCODONE HCL","5 MG","15","Select","Select",""],["","00713028031","BACITRACIN","500 UNIT\/G","14","Select","Select",""],["","65862042005","SULFAMETHOXAZOLE-TRIMETHOPRIM","800-160 MG","14","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":""}]}]}