{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"B   TTERBNOSPMOHT ","gend":0,"add":"R 1092TC NAY","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1974-10-09","age":"","mstatus":"","insh":"8954110*03","cliId":"","pno":"18\/7573594-6","cno":"757\/486-3333","email":"","ename":"","eno":"","pphy":"VANDERMEID, MARIA MD","ppno":"804\/968-5700","pcpadd":"5000 COX ROAD SUITE 100","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":"","pcpname":"PATIENT FIRST RICHMOND MEDICAL GROUP PLLC","plan":"OHP","program":"ACA","lob":"Small Group","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["U07.1","H33.023","Z20.828","Z09.","R05.","T85.22XA","Z98.890","H27.02","H33.002","Z00.00","M25.511","M19.011","M24.011","M25.522","R53.81","R19.7","Z48.03","F32.9","F41.9","D72.819","D72.1","D75.1","Z03.818","R10.9","S46.312A","R74.8","Z90.49","R11.0","Z83.3","Z82.49","Z82.5","Z80.3","Z01.818","N23.","R94.4","N28.9","R53.83","F41.1","F41.0","G89.18","K51.20","R63.4","R07.81","R00.1","Z79.890","Z79.899","Z96.1","Z98.41","R10.30","M66.822","S46.312D"],"date":["2021-07-02","2021-11-02","2021-04-01","2021-07-02","2021-04-01","2022-02-17","2022-02-17","2022-02-17","2022-02-17","2019-05-02","2019-12-11","2019-12-11","2019-12-11","2020-06-05","2020-09-07","2020-10-07","2020-09-07","2020-09-07","2020-09-07","2020-09-07","2020-09-07","2020-09-07","2020-10-07","2020-10-08","2020-09-03","2020-10-09","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-10-08","2020-03-16","2020-08-28","2020-08-28","2020-09-16","2020-11-11","2020-09-17","2020-09-17","2020-03-18","2020-11-11","2020-10-08","2020-10-08","2020-03-18","2020-03-18","2020-03-18","2020-08-01","2020-08-01","2020-10-08","2020-03-18","2020-08-04"],"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":[["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","-20","Select","Select",""],["","00363023820","STOOL","CAP 100MG","30","Select","Select",""],["","13668000801","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","35","Select","Select",""],["","24208063562","NEO\/POLY\/HC","SUS 1% OTIC","10","Select","Select",""],["","57237002901","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","65649030302","XIFAXAN","TAB 550MG","42","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","-30","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","90","Select","Select",""],["","01490032642","PEPTO-BISMOL","CHW 262MG","60","Select","Select",""],["","16729016901","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","23155050105","HYDROXYZ","TAB 25MG","28","Select","Select",""],["","61314063006","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","31722052630","FINASTERIDE","TAB 1MG","90","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","48102004701","DEXAMETHASON","TAB 4MG","20","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","80777027315","MODERNA","INJ COVID-19","0","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","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":[]}},{"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":""}]}]}