{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KEYONA D BURRELL","gend":1,"add":"377 BRANDYWINE LN","city":"MONTROSS","state":"VA","zip":"22520-9998","dob":"2000-08-14","age":"","mstatus":"","insh":"6539378*01","cliId":"","pno":8042380921,"cno":8042380921,"email":"","ename":"","eno":"","pphy":"WALKER, ANDREW F MD","ppno":8044939999,"pcpadd":"18849 KINGS HGHWY,","pcpcity":"MONTROSS","pcpstate":"VA","pcpzip":"22520-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z30.42","O99.011","H66.91","R51.9","G89.29","J01.00","Z32.02","Z68.26","Z20.822","R09.81","R07.0","R53.81","R53.83","R06.89","D50.0","O47.1","O99.013","O99.283","E88.81","Z3A.39","K21.9","J45.909","O26.93","Z68.33","Z11.52","O80.","Z37.0","Z3A.00","Z68.25","Z68.30","O48.0","O69.1XX0","O70.1","O99.52","O99.62","O99.02","Z3A.40","Z01.419"],"date":["2023-05-09","2022-03-18","2022-02-04","2022-05-15","2022-02-04","2022-02-04","2022-06-08","2021-09-16","2022-05-15","2022-05-15","2022-05-15","2022-05-15","2022-05-15","2022-05-15","2022-03-30","2022-03-26","2022-03-26","2022-03-26","2022-03-26","2022-03-26","2022-03-30","2022-03-30","2022-03-26","2022-03-18","2022-03-24","2022-03-31","2022-03-31","2022-03-31","2021-08-20","2022-01-19","2022-03-30","2022-03-30","2022-03-31","2022-03-30","2022-03-30","2022-03-30","2022-03-31","2022-08-31"],"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":[["","57237002801","AMOXICILLIN","TAB 500MG","30","Select","Select",""],["","59651036205","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","00363023820","STOOL SOFTNR","CAP 100MG","60","Select","Select",""],["","58602075521","PAIN RELIEF","TAB 500MG","30","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","30","Select","Select",""],["","66993037179","MEDROXYPR AC","INJ 150MG\/ML","1","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","66993037179","MEDROXYPROGESTERONE ACETATE","150 MG\/ML","1","Select","Select",""],["","68462010530","ONDANSETRON HCL","4 MG","12","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":""}]}]}