{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LLERRADSDLEIF ","gend":0,"add":"IFELTTAB 2687DAOR KRAP DLE","city":"HENRICO","state":"VA","zip":"23231-9998","dob":"1963-05-31","age":"","mstatus":"","insh":"0416110*93","cliId":"","pno":"9740810715","cno":"","email":"","ename":"","eno":"","pphy":"ASHRAFI, DARIUSH MD","ppno":8042262444,"pcpadd":"4620 S LABURNUM AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23231-9998","pcpcounty":"","pcpid":"","pcpname":"Laburnum Medical Center","plan":"OHP","program":"ACA","lob":"Small Group","region":"CENTRAL","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":["M79.605","D50.9","Z68.42","D64.9","R60.0","I10.","G47.30","K21.9","Z79.899","M25.562","M25.561","G89.29","M17.12","M17.0","Z68.43","I50.9","Z14.8","R53.83","Z79.891","G89.4","E66.01","G47.33","N17.9","Z98.84","E87.5","E87.1","E66.9","I12.9","N18.30","K92.1","Z91.14","R07.9","M79.89","D62.","Z13.220","Z51.81","S76.311A","R79.89","D47.3","K22.2","K29.30","K22.10","K64.8","K44.9","K64.4","K63.5","K29.70","G47.37","R06.02","R94.39","Z15.89","M79.2","Z86.2","Z01.812","Z20.822","Z12.11","Z13.228"],"date":["2021-06-30","2022-08-24","2021-09-22","2022-09-08","2021-06-02","2022-09-08","2022-07-06","2021-06-01","2023-05-30","2021-12-23","2022-07-14","2023-05-30","2021-12-30","2023-05-30","2022-11-03","2022-05-24","2022-05-24","2022-07-06","2022-08-17","2023-02-01","2022-09-15","2022-10-09","2022-09-08","2022-09-08","2022-09-08","2022-09-08","2022-09-08","2022-11-03","2022-11-03","2021-05-18","2021-05-18","2021-05-18","2021-06-18","2021-05-27","2021-12-23","2022-02-04","2022-08-15","2022-08-24","2021-05-25","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2022-10-09","2022-04-04","2022-04-04","2022-04-04","2021-05-26","2021-06-02","2021-11-05","2021-11-05","2021-08-30","2022-05-24"],"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":[]},{"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":[["","33342004910","IRBESARTAN","TAB 300MG","90","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","90","Select","Select",""],["","13668044201","CELECOXIB","CAP 200MG","10","Select","Select",""],["","68180029506","DULOXETINE","CAP 30MG","60","Select","Select",""],["","51672302002","LIDOCAINE","OIN 0.05","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","12","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","20","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","00378113401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","15","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","28","Select","Select",""],["","55566410001","EUFLEXXA","INJ 10MG\/ML","12","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","65862055990","PANTOPRAZOLE","TAB 20MG","90","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","65162062711","TRAMADOL HCL TAB","50MG","28","Select","Select",""],["","33342004910","IRBESARTAN TAB","300MG","90","Select","Select",""],["","58160088752","FLUARIX QUAD INJ","2021-22","0","Select","Select",""],["","00169452514","WEGOVY INJ","0.25MG","2","Select","Select",""],["","00781717612","NALOXONE SPR","","2","Select","Select",""],["","00406012405","HYDROCO\/APAP TAB","7.5-325","90","Select","Select",""],["","75987004005","PENNSAID SOL","2%","112","Select","Select",""],["","65162083366","DICLOFENAC GEL","1%","100","Select","Select",""],["","59267102501","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","29300039810","AMLODIPINE TAB","10MG","90","Select","Select",""],["","00310620530","FARXIGA TAB","5MG","30","Select","Select",""],["","00781107710","ALPRAZOLAM TAB","0.5MG","1","Select","Select",""],["","68382050010","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR TAB","10MG","20","Select","Select",""],["","70954005920","PREDNISONE TAB","10MG","30","Select","Select",""],["","16571020210","DICLOFENAC TAB","50MG DR","60","Select","Select",""],["","70954005930","PREDNISONE PAK","10MG","21","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","6","Select","Select",""],["","45963055650","GABAPENTIN CAP","300MG","30","Select","Select",""],["","00093094801","DICLOFEN POT TAB","50MG","60","Select","Select",""],["","00223172101","SODIUM BICAR TAB","650MG","90","Select","Select",""],["","00045083821","TYLENOL ARTHRITIS","650 MG","60","Select","Select",""],["","00406012405","HYDROCODONE-ACETAMINOPHEN","7.5-325 MG","90","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","300","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":""}]}]}