{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ENEGUESEMAJ ","gend":0,"add":"SORK5003TEERTS E","city":"RICHMOND","state":"VA","zip":"23234-6506","dob":"1966-10-14","age":"","mstatus":"","insh":"72012612","cliId":"","pno":"1340803744","cno":"","email":"","ename":"","eno":"","pphy":"REYNOLDS-CANE, DIANNE LENA","ppno":8047800840,"pcpadd":"1718 WILLIAMSBURG RD,","pcpcity":"Richmond","pcpstate":"VA","pcpzip":"23231-3428","pcpcounty":"","pcpid":"","pcpname":"GREATER FULTON MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"CENTRAL","aligned":"","ano":"","add2":"3005KROSE STREET","add3":"","madd1":"3005KROSE STREET","madd2":"","madd3":"","mcity":"RICHMOND","mstate":"VA","mzip":"23234-6506","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["B20","E11.65","E78.2","J45.30","I10","Z23","N30.01","R31.9","Z11.1","Z11.3","Z13.9","Z12.5","R89.9","Z71.89","R06.83","Z01.00","Z20.828","J40","S20.221A","G47.33","G47.30","Z72.51","J22","Z12.11","R80.9","J30.2","J45.998","J98.01","J18.9","Z87.891","E11.9","I25.810","J45.40","J06.9","M62.838","H57.12","R35.0","J98.8","B97.89","R05.1","Z20.822","D12.5","K64.8","Z86.010","K63.5","Z12.12","I73.9","I25.10","Z95.1","R00.1","R53.83","Z68.22","Z13.220","Z71.85","M19.041","M19.042","M79.641","M79.642","S41.152A","W50.3XXA","Z21"],"date":["2023-04-17","2022-04-14","2022-04-06","2022-04-06","2023-05-17","2023-05-17","2021-06-30","2021-06-30","2023-04-17","2023-04-17","2021-08-25","2022-10-13","2022-04-14","2021-09-08","2021-09-08","2021-09-08","2022-01-03","2022-01-03","2022-01-20","2022-10-05","2023-01-19","2022-04-06","2022-04-06","2022-12-29","2022-04-14","2022-04-26","2022-05-09","2022-04-26","2022-04-29","2022-05-09","2023-05-17","2022-07-21","2022-07-21","2022-08-17","2022-09-08","2022-09-08","2022-10-13","2022-12-15","2022-12-15","2022-12-17","2022-12-17","2022-12-29","2022-12-29","2022-12-29","2022-12-29","2022-12-29","2023-03-13","2023-03-06","2023-03-06","2023-03-06","2023-03-06","2023-03-06","2023-04-17","2022-10-13","2023-05-12","2023-05-12","2023-05-12","2023-05-12","2023-05-17","2023-05-17","2023-05-17"],"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":[["","70010049105","METFORMIN HCL","ER ORAL TAB","180","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","23","Select","Select",""],["","61958120101","STRIBILD","TAB","30","Select","Select",""],["","57664016758","METOPROL TAR","TAB 100MG","60","Select","Select",""],["","68180051202","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","180","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","00536105429","ASPIRIN","TAB 325MG","30","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","15","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","14","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","10572030201","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10.2","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00904674860","BISACODYL","TAB 5MG EC","4","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","300","Select","Select",""],["","00173086910","ANORO ELLIPT","AER 62.5-25","60","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":""}]}]}