{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  AHSYKALSENIAG S ","gend":1,"add":"IRC W 906DAOR FFE","city":"RICHMOND","state":"VA","zip":"23225-5305","dob":"1995-03-27","age":"","mstatus":"","insh":"5736408","cliId":"","pno":"0340891200","cno":8045981857,"email":"","ename":"","eno":"","pphy":"PENDYAL, KAUSALYA","ppno":8042377775,"pcpadd":"500 Hioaks Rd, Ste B","pcpcity":"Richmond","pcpstate":"VA","pcpzip":232254061,"pcpcounty":"","pcpid":"","pcpname":"","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":8045981857,"add2":"APT B","add3":"","madd1":"609 W CRIEFF ROAD","madd2":"APT B","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23225-5305","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O99.512","J10.1","Z3A.18","O99.352","Z34.92","G40.909","Z3A.21","Z3A.24","O47.03","O26.893","R10.30","O99.283","E86.0","O99.350","Z3A.29","Z3A.34","N93.8","Z32.01","M54.9","G89.29","N91.1","Z31.430","I21.29","I49.8","I51.7","N91.2","R56.1","O99.89","R10.84","Z3A.22","O26.892","R56.9","Z3A.27","Z3A.28","G40.901","Z87.898","Z91.19","Z46.82","J06.9","R05","R50.9","D64.9","F17.200","O26.859","R07.89","R51.9","O36.80X0","O99.353","Z39.2","N89.8","Z30.013","Z91.14","F17.210","F33.1","J96.00","N92.1","Z11.3","Z86.19","Z30.42","R06.02","R09.81","Z20.828","Z79.899","O42.913","Z3A.37","O69.81X0","Z37.0","Z20.822","R51","G43.009","F32.9","Z68.24","Z04.1","Z33.1","Z03.89","M79.661","Z3A.36","R10.9","Z3A.33","M79.604","J11.1","O00.90","O20.9","R31.9","Z3A.01","O02.81","F43.25","R07.9","W18.30XA","Z68.25","Z3A.35","F44.5","G43.109","Z68.20","S20.361A","F41.9","W57.XXXA","O99.354","O76","R00.0","F33.40","Z11.1"],"date":["2019-03-31","2019-03-31","2019-03-31","2019-06-12","2019-04-18","2020-08-03","2019-04-18","2019-05-15","2019-06-15","2019-08-10","2019-08-10","2019-06-15","2019-06-15","2019-08-10","2019-06-15","2019-07-24","2019-12-10","2020-10-29","2020-09-28","2020-09-28","2020-10-29","2020-10-29","2021-01-26","2021-01-26","2021-01-26","2019-01-15","2019-05-27","2019-04-25","2019-04-25","2019-04-25","2019-05-27","2021-01-26","2019-05-27","2019-06-12","2019-11-09","2019-11-07","2019-11-07","2019-11-07","2021-01-26","2021-01-26","2020-02-16","2020-02-16","2020-08-03","2020-09-26","2021-01-26","2021-01-26","2021-05-12","2019-08-10","2019-09-19","2019-09-19","2019-09-19","2019-11-07","2019-11-07","2020-11-17","2019-11-08","2019-12-12","2020-10-29","2019-12-12","2019-12-12","2020-06-22","2020-06-22","2020-06-22","2020-08-03","2019-08-10","2019-08-10","2019-08-10","2019-08-10","2021-01-26","2019-03-31","2019-06-03","2020-04-27","2019-04-17","2019-04-25","2019-05-27","2019-05-27","2019-07-18","2019-08-07","2019-06-15","2019-07-17","2019-07-18","2020-02-16","2020-09-26","2020-09-26","2020-09-26","2020-09-26","2020-09-28","2020-11-25","2021-01-26","2019-05-27","2019-06-03","2019-07-31","2020-04-27","2020-04-27","2020-04-27","2019-05-27","2019-05-27","2019-05-27","2019-08-10","2019-08-10","2019-11-07","2019-11-10","2020-01-07"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","64380080707","IBUPROFEN ","TAB 800MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP ","TAB 5-325MG","10","Select","Select",""],["","57237007710","ONDANSETRON ","TAB 4MG ODT","15","Select","Select",""],["","45802065087","LORATADINE ","TAB 10MG","15","Select","Select",""],["","00085075608","AFRIN ","SPR 0.0005","30","Select","Select",""],["","00536116361","MUCUS ","TAB 600MG ER","20","Select","Select",""],["","60432060416","PROMETHAZINE ","SYP DM","120","Select","Select",""],["","69315012710","FOLIC ","TAB 1000MCG","30","Select","Select",""],["","68180011302","LEVETIRACETA ","TAB 500MG","60","Select","Select",""],["","00093317431","ALBUTEROL ","FAT E","8.5","Select","Select",""],["","51672130406","TERCONAZOLE ","CRE 0.004","45","Select","Select",""],["","49884029001","MEGESTROL ","TAB 40MG","60","Select","Select",""],["","00093314705","CEPHALEXIN ","CAP 500MG","14","Select","Select",""],["","65862001105","SERTRALINE ","TAB 25MG","30","Select","Select",""],["","00131541071","VIMPAT ","SOL 10MG\/ML","200","Select","Select",""],["","59762453802","MEDROXYPR ","INJ 150MG\/ML","1","Select","Select",""],["","51862001601","NORTRIPTYLIN ","CAP 25MG","90","Select","Select",""],["","51224002230","AZITHROMYCIN ","TAB 250MG","4","Select","Select",""],["","59762500801","MISOPROSTOL ","200MCG","8","Select","Select",""],["","00093031401","KETOROLAC ","10MG","12","Select","Select",""],["","65862086495","SIMPESSE ","","91","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","14","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}