{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TAMRA CARTER","gend":1,"add":"4194 SCOTTS XRD","city":"CHASE CITY","state":"VA","zip":"23924-9998","dob":"2004-04-12","age":"","mstatus":"","insh":"9280006*01","cliId":"","pno":4343721541,"cno":4343721541,"email":"","ename":"","eno":"","pphy":"EBALO, NONNA L MD","ppno":4345723635,"pcpadd":"2202 BEECHMONT ROAD,","pcpcity":"SOUTH BOSTON","pcpstate":"VA","pcpzip":"24592-9998","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J02.0","G47.09","F32.1","Z23.","F41.1","N94.6","R11.2","R19.7","Z00.121","Z28.21","F41.8","E86.0","R10.84","F12.188","Z91.19","Z30.42","S91.132A","Z20.822","K21.9","Z30.46","J02.9","R10.12","R11.10","Z30.012","Z30.09","M79.644","R10.31","R63.0","R61.","R68.83","R00.0","R10.2","R10.9","E66.9","F17.290","F41.0","G47.00","M77.9"],"date":["2022-02-28","2022-05-19","2022-05-19","2022-03-16","2023-06-01","2022-07-11","2023-04-04","2023-04-04","2022-02-14","2022-02-14","2022-05-19","2022-07-12","2022-07-12","2022-07-12","2022-07-12","2023-01-10","2021-03-30","2021-11-10","2022-06-24","2022-04-06","2022-08-07","2021-09-28","2021-09-28","2022-03-23","2022-03-23","2023-02-17","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-06-01","2023-06-01","2023-06-20"],"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":[["","50111064701","FLUOXETINE","CAP 10MG","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","23155002305","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","68462030529","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","69097083412","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00093416178","AMOXICILLIN","SUS 400\/5ML","150","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","9","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","69097083412","SERTRALINE HCL","50 MG","30","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","18","Select","Select",""],["","42806015905","HYDROXYZINE HCL","10 MG","30","Select","Select",""],["","69842097417","DICLOFENAC SODIUM","1 %","50","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","30","Select","Select",""],["","50111064701","FLUOXETINE CAP","10MG","30","Select","Select",""],["","65862001501","AMOXICILLIN TAB","875MG","20","Select","Select",""],["","50111056001","TRAZODONE TAB","50MG","30","Select","Select",""],["","00228212750","CLONIDINE TAB","0.1MG","30","Select","Select",""],["","23155002305","BUSPIRONE TAB","5MG","60","Select","Select",""],["","65862085901","FAMOTIDINE TAB","20MG","30","Select","Select",""],["","68462030529","NORETHINDRON TAB","0.35MG","84","Select","Select",""],["","42806016005","HYDROXYZ HCL TAB","25MG","30","Select","Select",""],["","69097083412","SERTRALINE TAB","50MG","30","Select","Select",""],["","00093416178","AMOXICILLIN SUS","400\/5ML","150","Select","Select",""],["","65862039110","ONDANSETRON TAB","8MG ODT","9","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","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":""}]}]}