{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"REBECCA  A CLEMENS","gend":1,"add":"3161 CRAIG MILL ROAD","city":"SOUTH HILL","state":"VA","zip":"23970-9998","dob":"1984-02-06","age":"","mstatus":"","insh":"6931464*01","cliId":"","pno":4343219984,"cno":4343219984,"email":"","ename":"","eno":"","pphy":"ACKERMAN, CHRISTOPHER J MD","ppno":4348480771,"pcpadd":"203 SHARP ST","pcpcity":"LAWRENCEVILLE","pcpstate":"VA","pcpzip":"23868-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":4348483814,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L82.1","L91.8","Z41.9","D43.1","H04.123","H47.10","H52.13","J32.9","C71.9","S93.401A","S93.601A","E66.9","Z68.37","R50.9","J06.9","H66.92","U07.1","R07.0","Z85.841","V58.89","J30.89","J34.2","J34.3","G47.9","K21.9","J32.0","H93.11","H53.149","R43.8","R51.9","F32.9","D33.2","H40.023","C71.6"],"date":["2022-02-03","2022-02-03","2022-02-03","2022-02-07","2023-02-16","2022-02-24","2023-02-16","2022-05-26","2023-02-10","2021-09-07","2021-09-16","2021-10-07","2021-10-07","2022-11-25","2022-11-25","2022-11-25","2022-11-29","2022-01-08","2022-08-09","2021-10-07","2022-09-07","2022-09-07","2022-09-07","2022-09-07","2022-09-07","2022-09-07","2021-03-31","2021-03-31","2021-03-31","2021-03-31","2021-07-14","2021-07-14","2023-02-16","2022-02-09"],"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":[["","00093914701","VENLAFAXINE","TAB 25MG","30","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","13668000905","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","00378668877","PANTOPRAZOLE","TAB 20MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","8","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","7","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","14","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","00378064010","PREDNISONE","TAB 5MG","7","Select","Select",""],["","59651021430","AZELASTINE","SPR 0.001","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65162063609","PANTOPRAZOLE SODIUM","20 MG","30","Select","Select",""],["","59651021430","AZELASTINE HCL","137 MCG","30","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":""}]}]}