{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIAM F ZALESKI","gend":0,"add":"29214 TRAILER LN TRLR 24","city":"WAVERLY","state":"VA","zip":"23890-9998","dob":"1983-02-04","age":"","mstatus":"","insh":"3996360*01","cliId":"","pno":8046760136,"cno":8046760136,"email":"","ename":"","eno":"","pphy":"HOLLOMAN, HEATHER NP","ppno":8048348871,"pcpadd":"344 W MAIN ST","pcpcity":"WAVERLY","pcpstate":"VA","pcpzip":"23890-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8048348875,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.822","R68.89","M54.2","Z03.818","R10.9","K92.1","R19.5","R14.3","H91.90","H90.3","H61.23","H60.501","F31.9","Z68.25","K62.5","K64.1","K64.9","R10.84","Z11.52","U07.1","R51.9","R05.9","Z23.","J03.90","M62.830","R42.","Z79.899","K04.7","S46.001A","M25.511","Z11.59","M47.812","G44.209","R06.00","R11.0"],"date":["2022-01-24","2023-03-28","2022-04-06","2023-03-28","2023-01-20","2023-01-19","2023-01-19","2023-01-19","2021-07-29","2021-07-29","2021-07-29","2022-06-22","2022-11-03","2022-06-22","2023-02-07","2023-02-07","2023-02-07","2022-10-11","2021-12-13","2021-08-30","2022-02-28","2023-03-28","2021-06-18","2022-11-03","2021-11-12","2021-11-12","2021-11-12","2022-05-23","2023-04-07","2023-04-07","2021-10-25","2022-03-22","2022-03-22","2022-03-22","2022-03-22"],"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":[["","00781185220","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","12","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","65862014736","SUMATRIPTAN","TAB 50MG","20","Select","Select",""],["","70954006020","PREDNISONE","TAB 20MG","18","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","61442010301","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","51660012312","ANTI-DIARRHE","TAB 2MG","20","Select","Select",""],["","65862049460","QUETIAPINE","TAB 300MG","30","Select","Select",""],["","59651036105","IBUPROFEN","600 MG","20","Select","Select",""],["","29300011101","LAMOTRIGINE","25 MG","60","Select","Select",""],["","61314064511","NEO\/POLY\/HC","SUS 1% OTIC","10","Select","Select",""],["","00363013830","SENNA","TAB 8.6MG","30","Select","Select",""],["","68382041201","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","68180012201","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","29300041510","CYCLOBENZAPRINE HCL","10 MG","12","Select","Select",""],["","47335090288","QUETIAPINE FUMARATE","25 MG","60","Select","Select",""],["","10572010001","PEG-","3350 AND ELECTROLYTES 236-22.74G","4000","Select","Select",""],["","43386009019","GAVILYTE-G","236-22.74G","4000","Select","Select",""],["","00781261305","AMOXICILLIN","500 MG","40","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":""}]}]}