{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AZNOG A NYLREJZEUGIRDOR ZEL","gend":1,"add":"RBNWAL6057EVIRD KOO","city":"CHESTERFIELD","state":"VA","zip":"23237-1988","dob":"1991-11-09","age":"","mstatus":"","insh":"2624575","cliId":"","pno":"9240848088","cno":"","email":"","ename":"","eno":"","pphy":"PAINE, MATTHEW S","ppno":8047396142,"pcpadd":"13540 HULL STREET RD,","pcpcity":"Midlothian","pcpstate":"VA","pcpzip":"23112-2107","pcpcounty":"","pcpid":"","pcpname":"ST FRANCIS FAMILY MEDICINE CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"7506LAWNBROOK DRIVE","add3":"","madd1":"7506LAWNBROOK DRIVE","madd2":"","madd3":"","mcity":"CHESTERFIELD","mstate":"VA","mzip":"23237-1988","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N12","R10.13","Z86.2","Z79.1","R10.9","G44.311","R31.0","N39.0","R10.11","Z11.3","Z20.2","R30.0","R50.9","R11.0","A41.51","A41.9","Z20.822","N13.6","E87.6","Z88.1","Z88.5","Z87.440","Z87.442","Z90.49","N20.0","N13.30","R16.1","R11.2","B97.89","R10.31","N28.89","N10","B96.20","Z88.8","Z79.899","N13.2","R53.81","R30.9","Z56.0","R31.9","K31.84","Z96.0","Z98.51","B95.2","N13.4","N13.70","N13.5","N20.2","A04.72","N83.201","H57.89","Z98.890","R94.5","J39.2","N13.9","Z86.19","B96.29","A04.71","Z45.2","Z79.2","Z51.81","R68.83","N83.8","L29.9","N16","R63.8","E87.2","E86.0","R33.9","R11.10","K52.9","N11.1","R10.30","K66.0","N21.0","N83.00","Z88.6","R10.32","D72.829","R19.7","K52.89","A09","R10.33","R10.2","R93.3","F41.1","K21.9","B96.1","F39","R52","R39.14","R10.12","N11.9","N20.1","R39.15","R35.0","R00.0","Z48.816","R39.9","M54.9","E83.42","K63.89","K31.89","R16.0","Z16.29","Z87.448","B37.49","N26.1","A41.59","N83.01","N28.9","D62","R94.31","N32.89","D64.9","D69.6","K59.00","Z16.23","Z86.14","Z43.6"],"date":["2023-05-09","2021-03-06","2021-03-06","2022-10-30","2023-05-05","2021-04-30","2023-04-29","2023-05-05","2023-04-29","2021-05-24","2021-05-24","2023-03-16","2023-05-05","2022-12-17","2021-08-18","2023-03-22","2023-03-27","2023-05-11","2023-04-03","2023-04-20","2023-05-11","2023-05-18","2023-05-11","2023-05-11","2023-05-12","2023-05-18","2023-04-03","2023-04-23","2021-08-31","2023-05-11","2022-08-23","2023-04-20","2023-05-11","2023-01-10","2022-10-30","2023-04-29","2021-11-07","2023-04-29","2023-03-05","2023-05-05","2023-05-11","2022-11-27","2022-10-15","2023-04-17","2023-04-29","2023-05-24","2023-05-03","2022-11-28","2023-03-13","2022-08-23","2022-09-10","2022-01-21","2022-01-24","2022-04-04","2022-04-11","2022-11-03","2022-04-12","2022-04-12","2022-04-12","2023-05-18","2022-04-12","2022-04-24","2022-07-09","2022-07-08","2022-07-08","2022-07-08","2022-09-13","2022-07-19","2022-11-13","2022-11-27","2023-01-25","2023-01-10","2023-03-05","2022-09-02","2022-08-23","2022-08-23","2023-05-11","2022-12-17","2022-09-13","2022-11-03","2022-08-27","2022-08-25","2022-11-03","2022-08-29","2022-08-26","2022-09-10","2023-05-11","2023-03-28","2022-11-13","2022-10-30","2022-11-12","2022-12-17","2022-11-28","2022-12-08","2023-04-29","2023-04-29","2023-04-04","2023-04-27","2022-12-15","2022-12-17","2023-04-03","2023-01-10","2023-01-10","2023-01-10","2023-01-10","2023-01-12","2023-03-06","2023-03-06","2023-03-22","2023-03-22","2023-05-02","2023-04-03","2023-04-04","2023-04-03","2023-04-23","2023-04-23","2023-04-17","2023-05-11","2023-05-11","2023-05-18"],"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":[["","65862017760","CEFDINIR","CAP 300MG","14","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","21","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","5","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","20","Select","Select",""],["","80777027310","MODERNA VAC","INJ COVID-19","0.25","Select","Select",""],["","57896079901","GAS RELIEF","CHW 80MG","40","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","9","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","12","Select","Select",""],["","68180016113","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","00378113401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","75826011410","PHENAZOPYRID","TAB 100MG","18","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","30","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","10","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","14","Select","Select",""],["","68382013201","TAMSULOSIN","CAP 0.4MG","5","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","30","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","70954000520","OXYBUTYNIN","TAB 5MG","30","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","47781030701","NITROFUR MAC","CAP 50MG","30","Select","Select",""],["","42858030101","HYDROMORPHON","TAB 2MG","16","Select","Select",""],["","65862078201","METHENAM HIP","TAB 1GM","60","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","57237000430","FLUCONAZOLE","TAB 100MG","7","Select","Select",""],["","00378161001","DICYCLOMINE","CAP 10MG","30","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","41167005840","ASPERCREME","PAD LIDO 4%","10","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","68180016613","VANCOMYCIN","CAP 125MG","7","Select","Select",""],["","11917007192","WAL-DRYL","CAP 25MG","24","Select","Select",""],["","33342006707","OLANZAPINE","TAB 2.5MG","60","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","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":""}]}]}