{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAXWELL M DRAKE","gend":0,"add":"370 MOORE ST APT 203","city":"BRISTOL","state":"VA","zip":"24201-9998","dob":"1985-12-22","age":"","mstatus":"","insh":"2478753*01","cliId":"","pno":7572410589,"cno":7572410589,"email":"","ename":"","eno":"","pphy":"ANDREWS, ROY R DO","ppno":2766695179,"pcpadd":"2195 EUCLID AVE,","pcpcity":"BRISTOL","pcpstate":"VA","pcpzip":"24201-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"SOUTHWEST","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":2764668870,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.10","G47.00","E55.9","F10.20","R10.84","E87.2","F10.29","NO DATA","E83.42","E87.6","F41.1","M62.830","A41.9","E46.","E87.1","F10.239","I31.9","D69.6","E86.0","F12.10","F17.210","F41.9","G89.29","I11.9","K52.9","K76.0","R65.20","Z68.23","R30.0","R77.8","I30.0","D72.829","R11.2","E56.9","F10.129","R07.9","I34.0","Z86.79","R94.31","F10.988","I10.","Z20.822","F17.290","H10.89","I25.10","R79.89","G40.909","Z79.899","R00.1","I51.7","R07.89","R06.02","Z11.59","F10.21","F17.200","S40.812A","S40.811A","F10.120","R51.9","M54.2","Z23.","R11.0","F32.9","M62.838","M54.9","R00.0","N48.9","N17.9","R74.01","K92.0","K70.30","K57.30","F11.929","K29.20","F32.89","F10.230","Z74.3","M25.511","M25.311","F51.05","F99.","D69.59","K74.60","R29.6","K21.9","Z91.199"],"date":["2023-09-06","2023-09-06","2023-02-06","2023-01-23","2022-09-26","2022-09-26","2022-09-26","2023-09-06","2023-08-17","2023-08-17","2023-09-06","2022-11-16","2022-10-03","2022-09-26","2023-06-20","2023-08-20","2022-09-26","2022-11-08","2023-08-17","2022-09-26","2023-06-20","2023-08-20","2023-08-17","2022-09-26","2022-10-09","2022-10-09","2022-10-03","2022-09-26","2022-11-08","2022-11-16","2022-10-03","2023-07-28","2022-11-15","2022-12-14","2022-08-25","2023-08-17","2022-09-28","2022-10-02","2022-11-15","2022-10-09","2023-08-17","2022-11-08","2023-08-17","2022-11-08","2022-11-08","2022-11-08","2022-11-08","2023-06-20","2022-10-01","2022-10-01","2023-08-24","2022-11-15","2023-02-06","2023-02-06","2023-02-06","2022-08-26","2022-08-26","2022-08-26","2023-08-17","2022-10-09","2022-08-26","2022-08-26","2022-10-09","2022-10-09","2023-07-28","2023-07-29","2023-06-05","2023-07-28","2023-06-20","2023-08-17","2023-08-17","2023-08-17","2023-08-17","2023-08-17","2023-08-31","2023-07-28","2023-08-17","2023-08-29","2023-08-29","2023-08-22","2023-08-22","2023-07-28","2023-07-28","2023-07-28","2023-07-28","2023-07-28"],"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":[["","69097083512","SERTRALINE","TAB 100MG","28","Select","Select",""],["","65862049460","QUETIAPINE","TAB 300MG","28","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","28","Select","Select",""],["","00536135301","VITAMIN D3","CAP 50MCG","30","Select","Select",""],["","50428048545","CVS B-1","TAB 100MG","8","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","56","Select","Select",""],["","80681009800","VITAMIN B-1","TAB 100MG","28","Select","Select",""],["","76385012350","METHOCARBAM","TAB 500MG","10","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","69842031278","8HR PAIN ER","TAB 650MG","30","Select","Select",""],["","00555015902","CHLORDIAZEP","CAP 25MG","6","Select","Select",""],["","49483069901","ACETAMIN","TAB 650MG","30","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","40093010231","VIT D3 HP","CAP 2000UNIT","30","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","14","Select","Select",""],["","16571080901","QUETIAPINE FUMARATE","150 MG","180","Select","Select",""],["","00536135301","VITAMIN D","3 50 MCG","30","Select","Select",""],["","49483069901","ACETAMINOPHEN ER","650 MG","30","Select","Select",""],["","60505025103","TIZANIDINE TAB","2MG","28","Select","Select",""],["","50428048545","CVS B-","1 TAB 100MG","8","Select","Select",""],["","69097083512","SERTRALINE TAB","100MG","10","Select","Select",""],["","65862049460","QUETIAPINE TAB","300MG","5","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","56","Select","Select",""],["","31604001281","VITAMIN B-","1 100 MG","30","Select","Select",""],["","67877025130","TRIAMCINOLON CRE","0.1%","30","Select","Select",""],["","00555003302","CHLORDIAZEP CAP","10MG","6","Select","Select",""],["","76385012350","METHOCARBAM TAB","500MG","10","Select","Select",""],["","00378668910","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","24208091055","ERYTHROMYCIN OIN","5MG\/GM","4","Select","Select",""],["","40093010231","VIT D","3 HP CAP 2000UNIT","30","Select","Select",""],["","49483069901","ACETAMIN TAB","650MG","30","Select","Select",""],["","69097015807","MELOXICAM TAB","7.5MG","14","Select","Select",""],["","00555015802","CHLORDIAZEPOXIDE HCL","5 MG","44","Select","Select",""],["","40985022368","THERAPEUTIC-M","9MG-400MCG","30","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","4","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","69315012710","FOLIC ACID","1 MG","28","Select","Select",""],["","69315090510","LORAZEPAM","1 MG","6","Select","Select",""],["","42858000201","OXYCODONE HCL","10 MG","3","Select","Select",""],["","10006073038","MAGNESIUM OXIDE","400 MG","60","Select","Select",""],["","23155050201","HYDROXYZINE HCL","50 MG","30","Select","Select",""],["","59762040101","SUCRALFATE","1 G","360","Select","Select",""],["","76385012350","METHOCARBAMOL","500 MG","56","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","60","Select","Select",""],["","11917017677","MAGNESIUM","400 MG","28","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":""}]}]}