{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MAKALIA E BOOLE","gend":1,"add":"27224 HORSEY ROAD","city":"OAK HALL","state":"VA","zip":"23416-9998","dob":"1998-05-23","age":"","mstatus":"","insh":"5186838*01","cliId":"","pno":7578243650,"cno":7578243650,"email":"","ename":"","eno":"","pphy":"FQHC-HEALTH CENTER, ATLANTIC COMMUNITY FQHC","ppno":7578245676,"pcpadd":"5219 LANKFORD HWY,","pcpcity":"NEW CHURCH","pcpstate":"VA","pcpzip":"23415-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7578245872,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N93.9","F17.200","Z11.59","N64.4","W27.8XXA","R07.9","Z39.1","Z34.82","Z34.83","O77.9","Z3A.39","Z37.0","O90.89","R19.7","R11.2","R50.9","O99.335","F17.210","Z20.822","I49.9","O26.891","R55.","Z3A.12","O26.893","R10.2","O21.2","Z3A.32","Z79.899","J10.1","F31.9","R00.0","R05.9","R51.9","O99.891","O21.9","O99.331","O99.341","Z3A.13","O48.0","Z3A.40","R10.31","N39.0","B96.89","T14.91XA","F39.","Z71.3","O42.92","J98.11","Z23.","O99.214","O76.","Z88.8","O99.52","O99.62","K21.9","Z48.01","Z48.816","J06.9","J02.9","Z03.818","S21.012A","Z3A.01","O9A.211","S09.90XA","O99.613","NO DATA","O99.343","O99.333","Z3A.29","T42.6X2A","T42.4X2A","F33.9","R56.9","O98.519","Z3A.00","T50.901A","O20.8","O20.9","A74.9","Z09.","O99.330","S00.03XA","I49.8","O99.411","D72.829","Z86.59","R11.10","F32.9","Z71.6"],"date":["2021-02-16","2022-06-23","2021-05-04","2022-02-08","2022-02-08","2022-10-17","2022-12-12","2022-12-12","2022-12-12","2022-12-27","2022-12-27","2023-01-03","2023-02-06","2023-02-06","2023-02-06","2023-02-06","2023-02-06","2023-06-27","2023-02-06","2022-06-13","2022-06-23","2022-09-02","2022-06-13","2022-11-01","2023-01-20","2022-11-01","2022-11-01","2022-12-27","2022-11-25","2022-11-25","2022-11-25","2022-11-25","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2022-12-27","2023-01-03","2021-07-13","2021-07-12","2021-07-12","2022-02-16","2023-06-27","2023-06-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2022-12-27","2023-01-03","2023-01-03","2022-01-12","2022-01-12","2022-01-12","2022-02-08","2022-05-13","2022-06-23","2022-06-13","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-10-13","2022-02-16","2022-02-16","2022-02-16","2022-06-23","2022-11-25","2022-11-25","2022-02-16","2022-05-13","2022-05-13","2021-07-16","2021-07-16","2022-05-01","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2022-06-23","2023-06-27","2023-06-27"],"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":[["","16729013616","CLONAZEPAM","TAB 0.5MG","14","Select","Select",""],["","29300011105","LAMOTRIGINE","25 MG","60","Select","Select",""],["","00536408501","PRENATAL","TAB 28-0.8MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","16500055817","ONE A DAY","CAP PRENATAL","30","Select","Select",""],["","63044015005","PRENATAL VIT","TAB LOW IRON","30","Select","Select",""],["","58657017001","M-NATAL PLUS","TAB ","90","Select","Select",""],["","60258019309","PRENATABS RX","TAB ","30","Select","Select",""],["","69543026790","PNV TABS","TAB 29-1MG","30","Select","Select",""],["","00172572880","FAMOTIDINE","20 MG","60","Select","Select",""],["","00472022041","CLOTRIMAZOLE","CRE 0.01","45","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","12","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","69367026701","WESTAB PLUS","TAB 27-1MG","90","Select","Select",""],["","64380079901","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","42571016101","AMOX\/K CLAV","TAB 500-125","20","Select","Select",""],["","67555014830","OBTREX DHA","PAK ","90","Select","Select",""],["","40985027175","PRENATAL MV","","30","Select","Select",""],["","65162046650","IBUPROFEN","800 MG","90","Select","Select",""],["","10702001850","OXYCODONE","TAB 5MG","20","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00536440601","VITAMIN B-6","TAB 25MG","30","Select","Select",""],["","40985027175","PRENATAL VITAMIN + DHA","28-800-200","60","Select","Select",""],["","69618004410","DOCUSATE SODIUM","100 MG","60","Select","Select",""],["","16714020030","ONDANSETRON ODT","4 MG","20","Select","Select",""],["","55520000181","PRENATAL PLUS-DHA","267MCG-321","90","Select","Select",""],["","29300011210","LAMOTRIGINE TAB","100MG","60","Select","Select",""],["","16729013616","CLONAZEPAM TAB","0.5MG","14","Select","Select",""],["","00536440601","VITAMIN B-","6 TAB 25MG","30","Select","Select",""],["","00781261305","AMOXICILLIN CAP","500MG","20","Select","Select",""],["","00536408501","PRENATAL TAB","28-0.8MG","30","Select","Select",""],["","60258019309","PRENATABS RX TAB","","30","Select","Select",""],["","57237007530","ONDANSETRON TAB","4MG","12","Select","Select",""],["","69543026790","PNV TABS TAB","29-1MG","30","Select","Select",""],["","63044015001","PRENATAL VIT TAB LOW IRON","","30","Select","Select",""],["","58657017001","M-NATAL PLUS TAB","","30","Select","Select",""],["","16500055817","ONE A DAY CAP PRENATAL","","90","Select","Select",""],["","00472022041","CLOTRIMAZOLE CRE","1%","45","Select","Select",""],["","61442012110","FAMOTIDINE TAB","20MG","60","Select","Select",""],["","40985027175","PRENATAL MV MIS + DHA","","90","Select","Select",""],["","59762040105","SUCRALFATE TAB","1GM","120","Select","Select",""],["","67555014830","OBTREX DHA PAK","","90","Select","Select",""],["","69367026701","WESTAB PLUS TAB","27-1MG","90","Select","Select",""],["","67877032005","IBUPROFEN TAB","600MG","30","Select","Select",""],["","42571016101","AMOX\/K CLAV TAB","500-125","20","Select","Select",""],["","10702001850","OXYCODONE TAB","5MG","20","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","64380079901","OSELTAMIVIR CAP","75MG","10","Select","Select",""],["","64380074208","BUSPIRONE HCL","10 MG","60","Select","Select",""],["","68462050329","HAILEY FE","1.5-30(21)","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":""}]}]}