{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KATELYN WILLIS","gend":1,"add":"5072 OLD RICHMOND ROAD","city":"BLACKSTONE","state":"VA","zip":"23824-9998","dob":"1992-10-15","age":"","mstatus":"","insh":"2159450*01","cliId":"","pno":8049979663,"cno":8049979663,"email":"","ename":"","eno":"","pphy":"EGGLESTON III, WILLIAM MD","ppno":4342927261,"pcpadd":"213 NORTH MAIN ST","pcpcity":"BLACKSTONE","pcpstate":"VA","pcpzip":"23824-9998","pcpcounty":"","pcpid":"","pcpname":"Blackstone Family Practice Center","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4342927965,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I49.3","F41.1","R06.02","R10.84","R10.30","I95.9","R45.7","R53.82","U09.9","F41.0","E78.00","M51.36","R51.9","Z86.39","Z86.32","Z00.00","E53.8","E55.9","Z68.25","F33.1","S80.852A","J01.00","B96.89","R52.","B34.9","Z71.2","Z20.822","H65.90","J01.90","J02.9","K02.9","R53.1","R10.12","NO DATA","R26.81","R53.83","R09.81","R42.","F17.290","Z86.16","M51.26","M54.16","M54.6","V58.89","R55.","R11.0","R00.0","G89.29","J00.","K21.9","R06.89","R07.0","R10.9","I49.8","M54.5","K59.01","H92.09","Z68.24","F41.9","B37.3","R07.9","J06.9","M62.838","F17.210","R33.9","K04.01","H65.01","M54.2","R53.81"],"date":["2022-04-25","2023-05-09","2022-03-07","2022-03-07","2022-03-07","2022-03-07","2022-03-09","2022-05-09","2022-05-09","2023-05-09","2022-05-09","2022-05-09","2022-05-09","2022-05-09","2022-05-09","2022-05-09","2022-05-09","2022-05-09","2022-05-09","2023-05-09","2021-03-30","2021-05-01","2021-05-01","2022-01-06","2022-02-22","2021-01-04","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2022-02-22","2022-04-25","2022-04-25","2022-04-27","2022-04-25","2022-04-25","2022-04-25","2022-04-25","2022-04-25","2022-04-25","2022-04-27","2022-04-27","2021-03-04","2021-08-02","2022-03-05","2022-03-09","2022-05-09","2022-05-09","2021-04-30","2022-04-30","2022-03-05","2022-03-09","2022-03-09","2022-04-25","2021-07-26","2022-03-08","2022-04-05","2022-04-05","2022-04-30","2022-04-30","2021-03-05","2021-04-28","2021-09-01","2022-03-08","2022-03-08","2022-04-14","2021-05-07","2022-03-05","2022-03-09"],"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":[["","68462039710","OMEPRAZOLE","CAP 40MG","14","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","30","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","6","Select","Select",""],["","00574010770","CLOTRIMAZOLE","TRO 10MG","35","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","59651036205","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00143928501","AMOXICILLIN","TAB 875MG","14","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","57237004105","PENICILLN VK","TAB 500MG","28","Select","Select",""],["","11523723403","MIRALAX","POW 3350 NF","238","Select","Select",""],["","68180013701","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","45802086802","POLYETH GLYC","POW 3350 NF","238","Select","Select",""],["","00781107710","ALPRAZOLAM","TAB 0.5MG","20","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","11917007929","VITAMIN B-12","TAB 500MCG","30","Select","Select",""],["","11917017096","VITAMIN D3","CAP 2000UNIT","30","Select","Select",""],["","68382080510","TRAZODONE","TAB 50MG","30","Select","Select",""],["","74312019939","D3","CAP 50MCG","30","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","68382001901","VENLAFAXINE","TAB 37.5MG","30","Select","Select",""],["","43547028010","ESCITALOPRAM OXALATE","5 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":""}]}]}