{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HAZEL WORD","gend":1,"add":"11205 WILLOW OAK CT","city":"FREDERICKSBURG","state":"VA","zip":"22407-9998","dob":"1964-08-05","age":"","mstatus":"","insh":"2387997*01","cliId":"","pno":6178273589,"cno":6178273589,"email":"","ename":"","eno":"","pphy":"KALIDINDI, KAVITA MD","ppno":5402424141,"pcpadd":"3920 PLANK RD STE 120","pcpcity":"FREDERICKSBURG","pcpstate":"VA","pcpzip":"22407-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":5407862396,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","G43.909","N39.0","G89.29","M19.90","E55.9","F32.9","E87.6","R82.90","M25.552","M25.559","B00.9","E78.5","B20.","Z76.0","M16.12","E83.52","Z12.31","E66.9","M70.62","J45.909","M25.569","R73.03","E78.00","M85.80","F17.210","M25.551","R31.21","R39.89","NO DATA","M51.36"],"date":["2023-02-09","2023-02-09","2022-04-29","2023-04-20","2021-05-14","2021-05-14","2021-06-04","2023-02-09","2021-11-08","2023-02-09","2022-02-28","2022-02-28","2023-02-09","2023-02-09","2022-02-28","2022-10-12","2022-03-28","2022-03-28","2022-04-29","2023-04-13","2023-02-09","2023-02-09","2023-02-09","2021-11-01","2022-09-30","2021-06-04","2022-09-19","2022-04-26","2022-04-26","2023-04-20","2023-04-20"],"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":[["","59651029701","NIFEDIPINE","TAB 90MG ER","30","Select","Select",""],["","68382002310","ATENOLOL","50 MG","30","Select","Select",""],["","60505265601","TRIAMT\/HCTZ","TAB 37.5-25","30","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","61958210101","ODEFSEY","200-25-25","30","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","65862098799","POT CHLORIDE","TAB 10MEQ ER","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","49281042150","FLUZONE QUAD","INJ 2021-22","0","Select","Select",""],["","62037071001","POT CL MICRO","TAB 10MEQ CR","30","Select","Select",""],["","16571041110","CIPROFLOXACN","TAB 250MG","14","Select","Select",""],["","45802004475","ACYCLOVIR","CRE 0.05","5","Select","Select",""],["","47781030701","NITROFUR MAC","CAP 50MG","30","Select","Select",""],["","59779027468","ASPIRIN LOW","CHW 81MG","30","Select","Select",""],["","12843013105","BAYER LOW","CHW 81MG","30","Select","Select",""],["","62756052169","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","40","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","5","Select","Select",""],["","16571041250","CIPROFLOXACIN HCL","500 MG","10","Select","Select",""],["","69452034572","SUMATRIPTAN SUCCINATE","50 MG","40","Select","Select",""],["","12843013105","BAYER CHEWABLE ASPIRIN","81 MG","90","Select","Select",""],["","59651029701","NIFEDIPINE ER","90 MG","30","Select","Select",""],["","60505265601","TRIAMTERENE-HYDROCHLOROTHIAZID","37.5-25 MG","90","Select","Select",""],["","65862098799","POTASSIUM CHLORIDE","10 MEQ","90","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","47781030301","NITROFURANTOIN MONO-MACRO","100 MG","20","Select","Select",""],["","70377002811","ATORVASTATIN CALCIUM","20 MG","90","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":""}]}]}