{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AHTRAMSNEWO ","gend":1,"add":"OB O P849 X","city":"VANSANT","state":"VA","zip":24656,"dob":"1963-04-13","age":"","mstatus":"","insh":"60019460","cliId":"","pno":"1367288092","cno":"","email":"","ename":"","eno":"","pphy":"CHAUDHRY, FAISAL W","ppno":2763129088,"pcpadd":"1957 2ND ST,","pcpcity":"RICHLANDS","pcpstate":"VA","pcpzip":24641,"pcpcounty":"","pcpid":"","pcpname":"COMMUNITY HEALTH CLINIC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"SOUTHWEST","aligned":"","ano":"","add2":"P O BOX 948","add3":"","madd1":"P O BOX 948","madd2":"","madd3":"","mcity":"VANSANT","mstate":"VA","mzip":"24656-0948","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","R68.89","J18.1","Z12.11","M54.16","G89.29","R05","F17.210","J20.9","E11.42","Z79.4","L30.4","Z79.899","I10","E11.9","E78.5","E03.9","M25.571","R22.9","W19.XXXA","S92.241A","W01.0XXA","S92.321A","S92.331A","S92.341A","S92.351A","S92.231A","S92.311A","E11.649","S92.501A","W20.8XXA","S99.921A","W22.8XXA","Y92.019","Z79.1","Z88.6","Z88.5","S92.411B","S92.511B","M79.89","S92.901A","M79.671","S93.324A","S93.314A","S90.821A","S93.324D","S92.311D","S92.321D","S92.241D","S93.314D","T14.8XXA","Z01.818","Z20.828","I25.10","R91.8","G89.18","Y93.9","Y92.009","E11.65","F31.9","B19.20","F20.0","Z79.82","Z98.890","E11.621","L97.512","T81.89XA","Z79.84","Z48.01","T81.89XS","S91.301A","T81.89XD","L03.116","R60.0","H34.8120","M79.662","M25.572","M79.672","H35.3132","L97.513","Z51.81","S92.311K","Z87.828","R22.41","R22.42","Z48.00","N39.0","S92.321K","T84.223A","R09.89","Z53.09","I95.9","E11.40","J44.9","K21.9","L03.115","T85.79XA","Z20.822","M79.604","M79.605","J44.1","T84.293A","T84.629A","K86.1","B37.0","Z23","Z01.411","N94.10","R10.2","N76.1","Z12.31","Z12.4","Z78.0","M54.5","Z12.2","I73.9","R52","J01.90","J30.9","R60.9","J01.10","R11.0","R51.9","S92.411A","J43.9","X58.XXXD","E78.00","B37.9","Z99.81","R53.1","Z71.6","R06.09","Z74.3","Z72.0","J96.01","F20.9","R06.02","R41.82","R73.9","J81.1","R07.89","K85.90","R53.83","Z46.82","J96.90","R06.89","R06.00","Z91.89","I47.1","R39.81","R29.898","Z13.220","R73.09","Z13.228","Z13.0","R94.6","D64.9","G25.0","J96.21","R09.02","R00.0","J20.8","E78.2","E03.8","J02.9","M12.9","M62.81","M54.89","N28.89","Z76.0","Z00.00","N94.89","B37.2","B37.3","N28.1","K57.30","R16.1","N63.11","B17.10","G47.8","R92.8","N95.1"],"date":["2022-03-02","2021-02-19","2020-01-22","2020-02-04","2020-02-04","2021-12-15","2021-04-16","2021-12-15","2021-02-12","2020-02-04","2022-01-07","2020-02-05","2020-04-26","2022-03-23","2022-01-07","2022-03-23","2020-04-16","2020-04-26","2020-04-26","2021-11-23","2020-05-14","2020-04-26","2020-05-20","2020-04-26","2020-04-26","2020-04-26","2020-04-26","2020-05-20","2020-04-26","2020-04-26","2020-04-26","2020-04-26","2020-04-26","2020-04-26","2020-04-26","2020-04-26","2020-04-26","2020-04-26","2020-04-26","2021-02-16","2020-05-04","2021-11-23","2020-11-16","2020-05-14","2020-05-07","2021-12-15","2020-05-18","2020-05-18","2021-03-04","2021-03-04","2020-05-14","2021-02-16","2021-12-15","2022-03-23","2021-12-15","2020-05-20","2020-05-20","2020-05-20","2021-02-17","2022-03-23","2020-05-20","2021-12-17","2021-12-17","2020-06-16","2020-11-01","2020-11-01","2020-07-30","2022-01-07","2020-08-14","2020-09-04","2020-09-18","2021-04-01","2021-02-12","2021-03-08","2021-04-16","2020-08-03","2020-08-03","2020-08-03","2021-04-16","2020-09-04","2020-08-14","2021-03-04","2020-10-27","2020-08-27","2020-08-27","2020-09-04","2020-09-14","2021-03-04","2021-03-04","2020-11-16","2020-11-16","2022-01-06","2022-03-23","2022-03-23","2021-04-01","2021-02-16","2021-02-16","2022-01-07","2021-02-16","2021-02-16","2022-01-19","2021-02-16","2021-02-16","2021-04-01","2021-02-18","2021-02-16","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-02-22","2021-03-03","2022-03-23","2021-12-17","2021-04-13","2021-04-13","2021-04-13","2021-04-16","2021-04-16","2021-04-16","2021-11-23","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2021-12-15","2022-01-19","2022-01-10","2021-12-15","2022-04-08","2022-01-10","2022-01-06","2022-01-07","2022-01-07","2022-01-07","2022-01-07","2022-01-07","2022-01-19","2022-01-19","2022-01-12","2022-01-10","2022-01-19","2022-02-24","2022-01-31","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-02-09","2022-03-01","2022-03-23","2022-03-23","2022-04-08","2022-04-08","2019-05-30","2019-10-24","2019-10-24","2019-09-26","2019-03-22","2019-08-05","2019-08-06","2019-08-05","2019-05-11","2019-05-30","2019-05-30","2019-06-29","2019-07-25","2019-10-11","2019-08-05","2019-08-05","2019-08-06","2019-08-06","2019-08-06","2019-09-04","2019-10-24"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","13668003805","RISPERIDONE","13668003805 RISPERIDONE ","30","Select","Select",""],["","00832532511","POT  CL MICRO","00832532511 POT  CL MICRO","30","Select","Select",""],["","68382003510","VENLAFAXINE","68382003510 VENLAFAXINE ","30","Select","Select",""],["","68180046403","SIMVASTATIN","68180046403 SIMVASTATIN ","30","Select","Select",""],["","65862035705","CLOPIDOGREL","65862035705 CLOPIDOGREL ","30","Select","Select",""],["","16729018317","HYDROCHLOROT","16729018317 HYDROCHLOROT ","30","Select","Select",""],["","12496120803","SUBOXONE","12496120803 SUBOXONE ","56","Select","Select",""],["","40985027288","VITAMIN","40985027288 VITAMIN ","30","Select","Select",""],["","68001033408","LISINOPRIL","68001033408 LISINOPRIL ","30","Select","Select",""],["","70010006510","METFORMIN","70010006510 METFORMIN ","60","Select","Select",""],["","08470359001","UNIFINE","08470359001 UNIFINE ","100","Select","Select",""],["","00193658621","MICROLET","00193658621 MICROLET ","100","Select","Select",""],["","68001041203","GABAPENTIN","68001041203 GABAPENTIN ","90","Select","Select",""],["","73070010315","INSULIN","73070010315 INSULIN ","30","Select","Select",""],["","49483048110","ASPIRIN","49483048110 ASPIRIN ","30","Select","Select",""],["","64380080707","IBUPROFEN","64380080707 IBUPROFEN ","90","Select","Select",""],["","87701040752","GNP","87701040752 GNP ","30","Select","Select",""],["","00088221905","LANTUS","00088221905 LANTUS ","18","Select","Select",""],["","69315011610","FUROSEMIDE","69315011610 FUROSEMIDE ","6","Select","Select",""],["","00193731221","CONTOUR","00193731221 CONTOUR ","100","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","00574200802","NYSTOP","00574200802 NYSTOP ","60","Select","Select",""],["","00536589688","NICOTINE","00536589688 NICOTINE ","28","Select","Select",""],["","00591544205","PREDNISONE","00591544205 PREDNISONE ","35","Select","Select",""],["","68001035603","METOPROL","TAB 25MG ER","60.00","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10.20","Select","Select",""],["","33342002208","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","00781729685","ALBUTEROL","00781729685 ALBUTEROL ","6.7","Select","Select",""],["","00000000000",""," ","240","Select","Select",""],["","16714049401","AMOX\/K","TAB 500-125","20","Select","Select",""],["","68001025320","FLUCONAZOLE","68001025320 FLUCONAZOLE ","2","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","16729011917","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00143980350","DOXYCYCL","00143980350 DOXYCYCL ","20","Select","Select",""],["","57237023301","SMZ-TMP","57237023301 SMZ-TMP ","10","Select","Select",""],["","42423027101","ALCOHOL","42423027101 ALCOHOL ","100","Select","Select",""],["","65862042005","SMZ\/TMP","65862042005 SMZ\/TMP ","14","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","118","Select","Select",""],["","16714095502","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","16714076903","NYSTATIN","POW 100000","60","Select","Select",""],["","60505079204","ENOXAPARIN","INJ 40\/0.4ML","12","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","10","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","60","Select","Select",""],["","50484001030","SANTYL","OIN 250\/GM","30","Select","Select",""],["","68180012201","CEPHALEXIN","68180012201 CEPHALEXIN ","30","Select","Select",""],["","59267100001","PFIZER","59267100001 PFIZER ","0.3","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","49348004210","PAIN","49348004210 PAIN ","120","Select","Select",""],["","54838020980","SILTUSSIN-DM","SYP ALC FREE","240","Select","Select",""],["","65862018601","CLINDAMYCIN","65862018601 CLINDAMYCIN ","60","Select","Select",""],["","51672130200","TERCONAZOLE","51672130200 TERCONAZOLE ","20","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","30","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00193654621","BAYER","MIS LANCETS","100","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","00527134110","LEVOTHYROXIN","TAB 25MCG","15","Select","Select",""],["","08290326895","BD","PAD SNGL USE","100","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","56","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","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":{"indx":[["","",""],[""],[""],[""],[""]],"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":""}]}]}