{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEKENTRA L WILSON","gend":0,"add":"12 RAINEY RD","city":"SOUTH HILL","state":"VA","zip":"23974-9998","dob":"1981-12-11","age":"","mstatus":"","insh":"2236952*01","cliId":"","pno":4347553227,"cno":4347553227,"email":"","ename":"","eno":"","pphy":"BALMORIA, SANDRA MD","ppno":4344470876,"pcpadd":"1755 N MECKLENBURG AVE,","pcpcity":"SOUTH HILL","pcpstate":"VA","pcpzip":"23970-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4344470888,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F14.20","F31.32","M77.41","M77.42","B35.1","B35.3","M21.41","M21.42","G47.33","E66.01","F39.","J01.10","J02.9","R05.9","Z20.828","H66.91","J45.20","F15.20","F12.90","F41.1","J06.9","J45.21","F17.200","Z20.822","B34.2","M54.9","NO DATA","R51.9","T36.95XA","F10.20","F32.9","Z71.9","G47.19","E66.9","R82.90","Z23.","R03.0","Z79.899","Z83.3","Z72.89"],"date":["2022-07-12","2022-10-25","2023-05-24","2023-05-24","2023-05-24","2023-05-24","2023-05-24","2023-05-24","2023-08-21","2023-05-25","2023-05-25","2022-03-28","2022-03-28","2022-09-21","2022-03-28","2022-03-28","2022-03-28","2022-07-27","2022-07-27","2022-07-27","2022-09-21","2022-09-21","2022-10-11","2022-09-21","2021-12-31","2022-09-21","2023-06-29","2022-09-21","2022-09-21","2022-09-16","2021-03-08","2021-03-08","2022-09-21","2022-09-21","2023-06-29","2023-06-29","2023-06-29","2023-06-29","2022-10-11","2022-10-11"],"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":[["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","54838020940","SILTUSSIN-DM","SYP ALC FREE","118","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","65862022801","LAMOTRIGINE","TAB 100MG","30","Select","Select",""],["","33342007007","OLANZAPINE","TAB 10MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","50428046507","CVS COUGH DM","SUS 30MG\/5ML","118","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","21","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","6","Select","Select",""],["","45802014167","CICLOPIROX","8 %","6.6","Select","Select",""],["","00168009930","KETOCONAZOLE","2 %","30","Select","Select",""],["","00093101042","MUPIROCIN","2 %","22","Select","Select",""],["","21922002012","TAVABOROLE","5 %","10","Select","Select",""],["","54766077245","NAFTIN","2 %","45","Select","Select",""],["","23155000810","HYDROCHLOROTHIAZIDE","25 MG","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":""}]}]}