{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WANDA L BENITEZ","gend":1,"add":"2120 TINKER DR NE","city":"ROANOKE","state":"VA","zip":"24012-9998","dob":"1982-08-05","age":"","mstatus":"","insh":"2140621*01","cliId":"","pno":3478616668,"cno":3478616668,"email":"","ename":"","eno":"","pphy":"CALDWELL, KATELIN P NP","ppno":5409859715,"pcpadd":"102 HIGHLAND AVE STE 303,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":"24013-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5409859890,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.822","J45.901","J10.89","K57.92","R11.0","R10.2","R05.9","D64.9","Z20.828","R07.9","R06.02","N83.201","J32.9","J02.9","J06.9","B34.9","Z01.419","Z12.4","Z11.3","U07.1","J10.1","R19.7","B97.89","E66.9","Z68.42","R07.0","R07.2","R10.13","Z21.","R42.","B20.","R53.83","R63.5","E55.9","Z16.33","Z03.818"],"date":["2023-09-02","2022-07-23","2022-12-01","2021-11-16","2023-01-05","2021-11-16","2022-01-13","2022-11-25","2022-07-23","2023-01-05","2023-01-05","2021-11-16","2022-07-23","2022-07-23","2022-11-29","2021-10-10","2023-08-30","2022-08-02","2023-08-30","2022-09-06","2022-12-01","2022-12-01","2022-11-29","2023-01-05","2023-01-05","2022-11-29","2023-01-05","2023-01-05","2023-01-05","2023-01-05","2023-08-30","2021-03-29","2021-03-29","2021-03-29","2022-09-12","2021-11-27"],"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":[["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","59676057530","PREZCOBIX","800-150 MG","30","Select","Select",""],["","51991020311","FERREX 150","CAP 150MG","42","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","11523716102","CLARITIN-D","TAB 10-240MG","14","Select","Select",""],["","65162068090","PROMETHAZINE","SOL DM","120","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00904583315","LORATADINE-D","TAB 10-240MG","10","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","4","Select","Select",""],["","00378827052","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","51660048815",""," ","14","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","59676057530","PREZCOBIX TAB","800-150","30","Select","Select",""],["","11523716102","CLARITIN-D TAB","10-240MG","14","Select","Select",""],["","65162068090","PROMETHAZINE SOL DM","","120","Select","Select",""],["","69097014260","ALBUTEROL AER HFA","","7","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","00904583315","LORATADINE-D TAB","10-240MG","10","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","00378827052","ALBUTEROL NEB","0.083%","75","Select","Select",""],["","11877001140","BINAXNOW COV KIT HOME TES","","4","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","15","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":""}]}]}