{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B ASILNARW ","gend":1,"add":"TREBOR104EUNEVA S","city":"PETERSBURG","state":"VA","zip":"23805-2477","dob":"1961-09-12","age":"","mstatus":"","insh":"21013807","cliId":"","pno":"1340824712","cno":8048373195,"email":"","ename":"","eno":"","pphy":"WASHINGTON, KATERIA S","ppno":8044588583,"pcpadd":"1012 WINSTON CHURCHILL DR,","pcpcity":"Hopewell","pcpstate":"VA","pcpzip":"23860-5141","pcpcounty":"","pcpid":"","pcpname":"TWIN RIVERS MEDICAL CLINIC PC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"401ROBERTS AVENUE","add3":"","madd1":"401ROBERTS AVENUE","madd2":"APT 808","madd3":"","mcity":"PETERSBURG","mstate":"VA","mzip":"23805-2477","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.9","F20.9","F20.0","E11.9","S46.912A","B37.9","Z79.4","X58.XXXA","S46.812A","M54.2","I10","F32.9","B18.2","F17.210","Z90.710","Z88.5","Z82.49","Z83.3","Z79.1","F25.0","E11.65","R73.9","Z79.899","Z88.6","E11.69","Z68.23","F41.9","F39","Z91.11","K21.9","Z86.19","F17.218","F12.90","E11.8","Z12.31","Z68.22","S60.551A","T14.8XXA","L02.511","U07.1","J06.9","R05.9","F41.1","M79.644","R05.8","W45.8XXS","Y92.89","L03.011","S60.454S","Z79.84","Z79.82","J33.9","J34.89","R51.9","Z53.21","F14.20","F14.10","Z20.828","E78.5","F32.89","G47.00","F12.20","Z23","E11.649","E16.2","N28.9","E86.0","Z79.51","R20.2","Z03.89","I11.0","I50.9","R07.9","Z29.9","N17.9","E87.20","E11.22","E88.09","I13.0","D64.9","F32.A","G89.29","R53.1","N25.0","R07.89","E87.70","R25.2","R56.9","M54.50","M79.604","R52","N18.30","S99.921A","I12.9","M79.10","R29.818","R06.02","R94.31","V89.2XXA","M54.59","Z72.0"],"date":["2021-09-14","2021-09-14","2023-04-18","2023-02-08","2021-04-05","2021-04-05","2023-02-08","2021-04-05","2021-04-05","2023-04-07","2023-04-19","2022-10-17","2022-12-12","2022-11-09","2021-04-23","2021-04-23","2022-09-17","2022-09-17","2022-09-17","2023-05-19","2022-11-09","2021-04-23","2022-12-12","2022-09-17","2021-04-23","2021-04-23","2022-11-09","2021-09-07","2021-09-07","2022-04-11","2021-11-22","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-09-07","2021-11-22","2021-11-22","2021-11-22","2022-04-08","2021-11-22","2023-02-08","2022-04-11","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-12-11","2022-12-12","2022-04-20","2022-05-09","2023-02-08","2022-02-09","2022-05-12","2022-11-09","2022-04-08","2022-04-11","2022-04-11","2022-04-11","2022-04-11","2022-04-14","2022-10-04","2022-12-12","2022-11-09","2022-10-04","2022-09-17","2022-09-17","2022-10-04","2022-11-10","2022-11-16","2022-11-16","2022-11-14","2023-02-08","2022-11-09","2022-11-15","2022-11-09","2022-11-14","2022-11-09","2022-11-09","2022-11-09","2022-12-12","2022-11-09","2022-11-14","2022-11-09","2022-11-09","2022-11-09","2022-11-09","2022-11-09","2023-04-19","2022-11-15","2022-11-11","2022-11-15","2023-02-08","2023-02-08","2023-02-08","2023-02-08","2023-04-07","2023-04-07","2023-04-19"],"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":[["","67877024710","QUETIAPINE","TAB 300MG","30","Select","Select",""],["","68180097903","LISINOPRIL","TAB 40MG","30","Select","Select",""],["","60505014102","GLIPIZIDE","TAB 5MG","60","Select","Select",""],["","00781107710","ALPRAZOLAM","TAB 0.5MG","60","Select","Select",""],["","00363058714","ASPIRIN 81","TAB 81MG EC","30","Select","Select",""],["","31604002585","VITAMIN D","CAP 2000UNIT","30","Select","Select",""],["","68462039610","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","21","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","43598044774","NICOTINE TD","DIS 14MG\/24H","28","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10.2","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","29300039810","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","3","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","00193658621","MICROLET","MIS LANCETS","100","Select","Select",""],["","11917014455","ALCOHOL SWAB","PAD","100","Select","Select",""],["","29300046810","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","31722052001","HYDRALAZINE","TAB 25MG","90","Select","Select",""],["","64980052810","SODIUM BICAR","TAB 650MG","60","Select","Select",""],["","00054000725","CALCITRIOL","CAP 0.25MCG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00193730850","BAYER CONTOUR","NE XT 50CT","50","Select","Select",""],["","94046000174","PEN NEEDLES","MIS 31GX5MM","100","Select","Select",""],["","00093227534","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","12","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","24385030234","STOMACH RELF","SUS 262\/15ML","237","Select","Select",""],["","68382009810","PAROXETINE","TAB 20MG","30","Select","Select",""],["","43547028110","ESCITALOPRAM","TAB 10MG","24","Select","Select",""],["","23155050201","HYDROXYZ HCL","TAB 50MG","30","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","3","Select","Select",""],["","68382079901","LABETALOL","TAB 200MG","60","Select","Select",""],["","31722070110","LOSARTAN POT","TAB 50MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","40985027416","D3 SUPER STR","CAP 2000UNIT","30","Select","Select",""],["","68382013805","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","00904675180","ASPIRIN LOW","TAB 81MG EC","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":""}]}]}