{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JAMES TESTERMAN","gend":0,"add":"214 BEASLEY LN","city":"MARION","state":"VA","zip":"24354-9998","dob":"1965-11-06","age":"","mstatus":"","insh":"2405412*01","cliId":"","pno":2767838272,"cno":2767838272,"email":"","ename":"","eno":"","pphy":"HAMMAN, CHELSEA COFFEY MD","ppno":2767838123,"pcpadd":"1046 TERRACE DRIVE,","pcpcity":"MARION","pcpstate":"VA","pcpzip":"24354-9998","pcpcounty":"","pcpid":"","pcpname":"Royal Oak Medical Associates\/Dba Smyth County Family Physicians","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.9","I10.","K76.0","E74.01","R55.","NO DATA","I67.89","R13.19","R06.02","R09.02","F41.8","E78.5","Z74.3","R42.","K80.10","R11.0","R10.9","E87.1","R07.89","E87.6","F10.10","R11.2","K21.9","F41.9","R06.4","K80.80","Z79.899","R53.83","K70.30","I69.328","E83.42","I95.9","U07.1","Z68.31","F10.29","R74.01","M54.9","R05.","M79.602","R53.1","R10.84","R10.817","Z20.822","I35.0","Z82.49","R14.0","F10.239","T17.910A","K80.20","I21.4","J96.01","R77.8","J96.00","I42.1","J69.0","R05.9","M25.511","F10.988","R13.10","W01.198A","Z72.89","I16.0","R07.1","R19.7","R51.9","R94.31","Z90.49","Z86.73","Z87.19","Z28.21","Z79.51","Z79.82","R07.2","E83.51","K92.0","I15.8","R00.0","N20.1","R61."],"date":["2022-06-11","2022-07-09","2021-08-22","2021-08-22","2022-03-10","2022-03-14","2022-03-14","2022-03-14","2022-05-30","2022-06-11","2022-07-09","2022-03-14","2022-05-30","2022-05-30","2022-07-09","2022-07-09","2022-07-09","2022-01-18","2022-05-30","2021-12-09","2022-01-18","2022-06-12","2022-05-30","2022-05-30","2022-05-30","2022-06-12","2022-06-12","2022-06-12","2021-09-06","2022-01-18","2022-02-03","2022-02-03","2022-02-03","2022-02-03","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-08-22","2021-10-06","2021-08-22","2022-01-17","2021-12-27","2021-12-27","2022-03-09","2022-03-09","2022-03-09","2022-07-09","2022-01-21","2022-01-21","2022-01-21","2022-01-22","2021-12-08","2022-03-08","2022-03-08","2022-03-10","2022-03-10","2022-03-10","2022-03-10","2022-03-16","2022-01-17","2022-01-17","2022-03-16","2022-01-21","2022-01-21","2022-01-21","2022-01-21","2022-01-21","2022-01-21","2022-01-21","2022-01-21","2022-03-16","2022-03-16","2021-08-22","2021-12-16","2022-06-11","2022-06-11","2022-06-11"],"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":[["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","60","Select","Select",""],["","29300013601","CLONIDINE","TAB 0.2MG","30","Select","Select",""],["","68645055654","LISINOP\/HCTZ","TAB 10-12.5","30","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","68645055354","LISINOPRIL","TAB 20MG","30","Select","Select",""],["","57237001930","DULOXETINE","CAP 60MG","30","Select","Select",""],["","68645013054","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","72205002790","ROSUVASTATIN","TAB 5MG","30","Select","Select",""],["","49035046708","ASPIRIN 81MG","CHE WABLE TABLETS","30","Select","Select",""],["","00555015802","CHLORDIAZEP","CAP 5MG","15","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","68180044501","QUETIAPINE","TAB 25MG","30","Select","Select",""],["","35573042880","PANTOPRAZOLE","TAB 40MG DR","30","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00904404073","ASPIRIN","CHW 81MG","30","Select","Select",""],["","60505024701","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","65862017760","CEFDINIR","CAP 300MG","10","Select","Select",""],["","69238110002","DOXYCYCL HYC","CAP 100MG","10","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","70710112307","DOXYCYC MONO","TAB 100MG","20","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","00904549280","THERA-M","TAB ","30","Select","Select",""],["","00536329736","CHILD ASA","CHW 81MG","30","Select","Select",""],["","13668010401","ISOSORB MONO","TAB 30MG ER","30","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","10","Select","Select",""],["","68645059459","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","13668001001","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","00013046768",""," ","30","Select","Select",""],["","00555015802","CHLORDIAZEP CAP","5MG","15","Select","Select",""],["","00536329736","CHILD ASA CHW","81MG","30","Select","Select",""],["","35573042880","PANTOPRAZOLE TAB","40MG DR","30","Select","Select",""],["","68645055354","LISINOPRIL TAB","20MG","30","Select","Select",""],["","60505024701","MIRTAZAPINE TAB","15MG","30","Select","Select",""],["","00904404073","ASPIRIN CHW","81MG","30","Select","Select",""],["","29300013601","CLONIDINE TAB","0.2MG","30","Select","Select",""],["","57237001930","DULOXETINE CAP","60MG","30","Select","Select",""],["","68180071160","CEFDINIR CAP","300MG","10","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","69238110002","DOXYCYCL HYC CAP","100MG","10","Select","Select",""],["","43547040111","FUROSEMIDE TAB","20MG","60","Select","Select",""],["","70710112307","DOXYCYC MONO TAB","100MG","20","Select","Select",""],["","68462015713","ONDANSETRON TAB","4MG ODT","10","Select","Select",""],["","72205002790","ROSUVASTATIN TAB","5MG","30","Select","Select",""],["","00904549280","THERA-M TAB","","30","Select","Select",""],["","68645059459","FAMOTIDINE TAB","20MG","30","Select","Select",""],["","00143122701","DICYCLOMINE TAB","20MG","20","Select","Select",""],["","13668010401","ISOSORB MONO TAB","30MG ER","30","Select","Select",""],["","68180044501","QUETIAPINE TAB","25MG","30","Select","Select",""],["","13668001001","CITALOPRAM TAB","20MG","30","Select","Select",""],["","59746011506","PROCHLORPER TAB","10MG","10","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":""}]}]}