{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VALERIE WEBB","gend":1,"add":"102 STEELE AVE","city":"FRONT ROYAL","state":"VA","zip":"22630-9998","dob":"1974-07-04","age":"","mstatus":"","insh":"2193176*01","cliId":"","pno":5613527838,"cno":5613527838,"email":"","ename":"","eno":"","pphy":"MAXFIELD, BRIANNA PA","ppno":5405365500,"pcpadd":"611 EAST JUBAL EARLY DRIVE,","pcpcity":"WINCHESTER","pcpstate":"VA","pcpzip":"22601-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5405365507,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J20.9","Z20.828","R09.81","G47.10","K80.10","K91.2","D50.8","D52.0","E21.1","E55.9","E66.9","K80.50","R10.12","R10.11","R11.2","R19.7","Z79.899","Z20.822","R10.13","Z98.84","K80.20","F32.9","Z01.818","I10.","R11.0","F17.210","G47.00","L30.9","H35.033","E66.09","F98.8","Z68.37","K76.89","N92.3","Z80.49"],"date":["2021-11-08","2021-11-08","2021-11-08","2023-03-09","2023-05-03","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2023-03-13","2023-03-14","2023-03-14","2023-03-13","2023-03-13","2023-03-13","2023-03-13","2023-04-05","2023-04-05","2023-03-13","2021-07-13","2023-04-21","2023-04-05","2023-03-13","2023-03-13","2021-07-13","2021-07-13","2023-07-11","2023-03-09","2023-03-09","2023-03-09","2023-04-05","2021-10-11","2021-10-11"],"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":[["","00185085301","AMPHET\/DEXTR","TAB 20MG","60","Select","Select",""],["","00555902858","JUNEL FE","1.5-30(21)","84","Select","Select",""],["","54092038701","ADDERALL XR","CAP 20MG","30","Select","Select",""],["","10370010150","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","00603459315","METHYLPRED","TAB 4MG","21","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","16729017017","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","59651036205","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","81968035101","SUNOSI","150 MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","8","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","43547048610","METHYLPHENID","TAB 5MG","30","Select","Select",""],["","13668013710","ESCITALOPRAM OXALATE","20 MG","90","Select","Select",""],["","64380071207","BENZONATATE","100 MG","30","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","48","Select","Select",""],["","33342008741","RIZATRIPTAN","5 MG","8","Select","Select",""],["","24658031205","DOXYCYCLINE HYCLATE","100 MG","14","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","6","Select","Select",""],["","42858010201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","20","Select","Select",""],["","00904673080","ACETAMINOPHEN","500 MG","90","Select","Select",""],["","68001044503","POTASSIUM CHLORIDE","20 MEQ","28","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM","40 MG","60","Select","Select",""],["","00254101196","SUCRALFATE","1 G\/10 ML","1200","Select","Select",""],["","70436001002","BUPROPION XL","150 MG","90","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HCL","10 MG","15","Select","Select",""],["","00527128201","DICYCLOMINE HCL","20 MG","10","Select","Select",""],["","68462039710","OMEPRAZOLE","40 MG","90","Select","Select",""],["","68001024617","ONDANSETRON ODT","4 MG","20","Select","Select",""],["","00555097202","DEXTROAMPHETAMINE-AMPHETAMINE","10 MG","30","Select","Select",""],["","00115148901","AMPHET\/DEXTR CAP","20MG ER","30","Select","Select",""],["","00185085301","AMPHET\/DEXTR TAB","20MG","60","Select","Select",""],["","54092038701","ADDERALL XR CAP","20MG","30","Select","Select",""],["","10370010150","BUPROPN HCL TAB","150MG XL","90","Select","Select",""],["","00555902858","JUNEL FE TAB","1.5\/30","28","Select","Select",""],["","00603459315","METHYLPRED TAB","4MG","21","Select","Select",""],["","29300012810","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","16729017017","ESCITALOPRAM TAB","20MG","30","Select","Select",""],["","59651036205","IBUPROFEN TAB","800MG","30","Select","Select",""],["","81968035101","SUNOSI TAB","150MG","30","Select","Select",""],["","00093310905","AMOXICILLIN CAP","500MG","21","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","30","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","8","Select","Select",""],["","43547048610","METHYLPHENID TAB","5MG","30","Select","Select",""],["","00169452514","WEGOVY","0.25MG\/0.5","2","Select","Select",""],["","68382013805","TOPIRAMATE","25 MG","173","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":""}]}]}