{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PATRICE A BROWN","gend":1,"add":"2708 SALEM TPKE","city":"ROANOKE","state":"VA","zip":"24017-9998","dob":"1985-04-28","age":"","mstatus":"","insh":"2174706*01","cliId":"","pno":5403426934,"cno":5403426934,"email":"","ename":"","eno":"","pphy":"KEILMAN, DAVID MD","ppno":5402651607,"pcpadd":"4910 VALLEY VIEW BLVD,","pcpcity":"ROANOKE","pcpstate":"VA","pcpzip":"24012-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"ROANOKE ALLEGHANY","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5403667353,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.99","F12.99","F14.99","Z39.1","O77.0","O98.32","Z37.0","O70.1","A60.09","F17.200","F31.9","O99.334","O99.344","Z3A.40","F33.3","Z56.9","Z79.899","Z59.9","R10.11","R52.","Z20.822","F41.9","O23.43","NO DATA","Z3A.36","Z53.29","Z86.59","Z04.89","O26.893","R07.81","Z3A.29","Z53.21","Z34.82","Z29.13","Z65.8","Z71.89","U07.1","R50.9","J06.9","B97.89","R51.9","R10.9","O62.9","O09.523","O80.","J02.9","R69.","G89.29","M54.32","M62.838","M95.5","M62.81","E66.9","R53.81","L25.9","R21.","Z36.89","Z3A.33","Z23.","Z72.0","R94.31","F33.0","V62.84"],"date":["2022-11-16","2022-11-16","2022-11-16","2022-01-31","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-03-03","2022-12-19","2022-04-12","2022-03-03","2022-03-03","2022-03-03","2022-11-30","2022-06-23","2023-02-12","2022-06-23","2022-06-26","2022-06-26","2023-01-04","2023-08-31","2021-12-15","2021-12-15","2021-12-15","2023-02-12","2023-02-12","2023-02-12","2022-03-02","2022-03-02","2021-12-15","2021-12-15","2021-12-16","2021-12-16","2022-01-20","2022-02-18","2022-05-11","2022-05-11","2022-12-19","2022-12-19","2022-12-19","2021-12-15","2022-03-02","2022-03-02","2022-03-03","2022-05-11","2023-02-12","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2021-01-27","2022-04-12","2022-12-18","2023-04-15","2023-04-15","2022-01-07","2022-01-07","2022-01-07","2022-12-19","2023-02-12","2023-08-31","2023-08-10"],"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":[["","31722070530","VALACYCLOVIR","TAB 1GM","30","Select","Select",""],["","65862049101","QUETIAPINE","TAB 100MG","90","Select","Select",""],["","00536100901","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","68462053670","IMIQUIMOD","CRE 0.05","6","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","15","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","8","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","80777028299","MODERNA BIVA","INJ BA4\/BA5","0","Select","Select",""],["","64380071307","BENZONATATE","CAP 200MG","30","Select","Select",""],["","59779065034","TUSSIN ADULT","LIQ 100\/5ML","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","30","Select","Select",""],["","45802005435","TRIAMCINOLONE ACETONIDE","0.025 %","30","Select","Select",""],["","80777028299","MODERNA COVID BIVAL (","6Y UP)EUA 50 MCG\/0.5","0.5","Select","Select",""],["","60008040780","INDICAID COVID-","19 AG HOME TEST","8","Select","Select",""],["","56362000589","IHEALTH COVID-","19 AG HOME TEST","8","Select","Select",""],["","00603533815","PREDNISONE","10 MG","21","Select","Select",""],["","31722070430","VALACYCLOVIR TAB","500MG","30","Select","Select",""],["","00536100901","FERROUS SULF TAB","325MG","30","Select","Select",""],["","67877024201","QUETIAPINE TAB","25MG","30","Select","Select",""],["","65862001205","SERTRALINE TAB","50MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","20","Select","Select",""],["","68462053670","IMIQUIMOD CRE","5%","6","Select","Select",""],["","49483060450","IBUPROFEN TAB","800MG","15","Select","Select",""],["","82607066026","FLOWFLEX KIT TEST","","8","Select","Select",""],["","80777028299","MODERNA BIVA INJ BA","4\/BA5","0","Select","Select",""],["","70461032203","FLUCLVX QUAD INJ","2022-23","0","Select","Select",""],["","64380071307","BENZONATATE CAP","200MG","30","Select","Select",""],["","59779065034","TUSSIN ADULT LIQ","100\/5ML","30","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","30","Select","Select",""],["","80777028299","MODERNA COVID BIVAL (6Y UP)","EUA","0.5","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":""}]}]}