{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TIFFANY  F BRASWELL","gend":1,"add":"11311 GENITO ROAD STE 201","city":"AMELIA COURT HOUSE","state":"VA","zip":"23002-9998","dob":"1995-09-12","age":"","mstatus":"","insh":"5064104*01","cliId":"","pno":8045733429,"cno":8045733429,"email":"","ename":"","eno":"","pphy":"DODD, JEFFREY MD","ppno":8048972159,"pcpadd":"2891 ANDERSON HWY,","pcpcity":"POWHATAN","pcpstate":"VA","pcpzip":"23139-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8042505774,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G40.909","F41.0","S80.12XA","R20.2","L02.93","F33.1","K64.9","E78.00","Z79.899","E55.9","F17.200","N76.0","R30.9","D50.9","NO DATA","L73.9","F31.2","R53.82","Z76.89","D64.9","Z11.3","Z13.1","Z13.220","L03.113","R56.9","Z68.24","F40.01","J20.9","F15.20","N92.6","Z20.2","F41.8","Z01.419","K04.7"],"date":["2023-06-15","2023-06-15","2022-05-19","2022-05-19","2022-05-19","2022-08-03","2022-04-19","2023-06-15","2022-04-19","2022-04-19","2023-06-15","2023-06-15","2022-08-16","2022-08-16","2023-06-15","2022-06-16","2022-06-29","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-10-09","2021-03-04","2021-03-04","2022-03-08","2022-11-16","2023-06-21","2023-06-15","2023-06-15","2023-06-15","2023-06-15","2023-06-15"],"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":[["","69097081507","GABAPENTIN","400 MG","90","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","15","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","30","Select","Select",""],["","13668001005","CITALOPRAM","TAB 20MG","30","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","19","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","16571041250","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","69097081507","GABAPENTIN CAP","400MG","90","Select","Select",""],["","00093083205","CLONAZEPAM TAB","0.5MG","30","Select","Select",""],["","00378064205","PREDNISONE TAB","20MG","19","Select","Select",""],["","62559043130","HYDROCORTISO CRE","2.5%","30","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","30","Select","Select",""],["","13668001005","CITALOPRAM TAB","20MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM TAB","10MG","30","Select","Select",""],["","50111033401","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","16571041250","CIPROFLOXACN TAB","500MG","14","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","70436005901","BUPROPION HCL SR","150 MG","60","Select","Select",""],["","49483060350","IBUPROFEN","600 MG","30","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","14","Select","Select",""],["","65862001501","AMOXICILLIN","875 MG","14","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":""}]}]}