{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"HSEMINLETAP ","gend":0,"add":"LE 0876DAOR K","city":"NORTH CHESTERFIELD","state":"VA","zip":"23224-9998","dob":"1964-01-10","age":"","mstatus":"","insh":"0453210*01","cliId":"","pno":"2840839582","cno":8048228593,"email":"","ename":"","eno":"","pphy":"GIUNTA, SUZANNE M MD","ppno":8042307777,"pcpadd":"4730 N SOUTHSIDE PLAZA","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":"23224-9998","pcpcounty":"","pcpid":"","pcpname":"MCV ASSOCIATED PHYSICIANS","plan":"OHP","program":"ACA","lob":"Individual","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":["N18.32","R79.89","R78.81","A49.01","Z94.4","I10.","D84.9","Z12.11","M85.88","Z13.820","K70.30","I45.10","K70.31","I85.10","R60.0","N50.89","D64.9","D69.6","D68.9","E78.00","Z82.49","Z87.891","R50.9","L03.114","I80.9","B95.61","J93.9","J90.","J18.1","I51.7","J98.19","J81.1","Z46.82","Z49.01","K76.7","R57.8","J96.01","A41.01","N17.0","R65.21","K66.1","K83.1","K76.6","J94.2","Q24.5","D62.","J91.8","E87.1","N17.9","D72.829","K74.60","K80.10","R06.89","Z46.59","T86.49","R74.8","R18.8","R49.0","Z48.23","Z79.899","N17.8","E87.5","E87.2","R93.3","K63.89","Z98.890","K83.8","Z90.49","Z97.8","Z51.81","F10.10","Z11.59","E78.5","R94.4","F10.99","K91.89","L03.115","F10.11","D53.9","B35.4","N43.3","K72.10","R60.9","I85.00","K76.9","K80.20","R91.8","J98.11","I27.89","I08.1","I70.0","J98.4","Z95.828","E87.4","J96.00","F10.988","K72.91","I50.9","Z01.810","K72.90","Z45.2","R17.","Z23.","T85.858A","F10.21","R60.1","I49.1","Z48.813","J43.9","I27.29","R14.0","M79.89","Z96.89","D72.819","D70.2","E87.70","R53.1","R16.1","J94.8","R09.02","R57.9","J95.830","J98.6","I74.8","N28.9","Z88.1","Z91.89","K59.39","A41.9","I25.2","R94.5","Z09.","Z01.818","R00.1","Z76.82","Z48.02","J38.3","R13.10","K21.9","M62.89","E83.40","D84.821","Z79.82","T85.520A","T85.628A","E78.49","J38.7","T85.590A","L30.0","D18.01","L30.9","D68.4","N48.89","D63.8","Z91.14","L85.3","S27.1XXA","Z99.2","I87.8","I15.9","F10.20"],"date":["2023-05-24","2023-01-18","2021-10-21","2021-10-21","2023-03-30","2022-12-22","2023-03-30","2022-07-13","2022-10-28","2022-10-28","2021-10-22","2021-09-22","2023-05-09","2021-09-23","2021-10-22","2021-08-15","2021-12-07","2021-09-22","2021-09-23","2021-08-15","2021-09-06","2022-03-10","2021-09-11","2021-09-14","2021-09-14","2021-10-13","2021-10-01","2021-10-15","2021-09-15","2021-10-14","2021-09-28","2021-10-13","2021-09-29","2021-09-16","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2021-09-23","2022-12-22","2021-10-15","2021-10-15","2021-09-23","2021-10-13","2021-09-23","2021-09-23","2021-10-15","2021-09-22","2021-09-23","2021-09-23","2021-10-14","2022-08-04","2021-10-22","2022-01-06","2021-10-12","2021-11-08","2022-04-21","2022-12-22","2021-10-08","2023-03-30","2021-10-08","2021-10-09","2021-10-11","2021-10-13","2022-08-04","2021-10-14","2021-10-14","2021-11-16","2022-12-22","2022-04-19","2023-05-09","2022-02-10","2022-02-10","2022-08-09","2021-08-05","2021-07-09","2021-07-07","2021-07-27","2021-07-23","2021-07-23","2021-07-23","2021-09-21","2021-09-03","2021-09-12","2021-10-14","2021-10-14","2021-09-12","2021-09-13","2021-10-12","2021-10-12","2021-10-03","2021-09-19","2021-09-19","2021-09-22","2021-09-22","2021-09-22","2021-09-22","2021-09-23","2021-10-14","2021-10-01","2022-12-22","2022-08-09","2021-08-10","2021-08-15","2021-09-02","2021-09-09","2021-09-16","2021-09-16","2021-10-12","2021-10-15","2022-01-20","2021-12-07","2022-01-06","2021-08-25","2021-09-02","2021-09-06","2021-09-18","2021-09-12","2021-09-15","2021-09-16","2021-10-12","2021-10-12","2021-08-10","2021-08-10","2021-08-05","2021-09-12","2021-09-19","2021-09-21","2021-09-30","2022-01-20","2022-12-22","2021-09-12","2021-09-21","2021-10-19","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2021-12-07","2021-12-07","2021-12-07","2022-04-21","2021-10-12","2021-10-22","2021-11-08","2022-04-21","2023-02-13","2023-02-13","2021-01-30","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-25","2021-09-12","2021-09-18","2021-09-06","2023-03-30","2023-05-09"],"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":[["","00168000415","TRIAMCINOLON","CRE 0.001","60","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00378395105","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","69097086707","NADOLOL","TAB 20MG","30","Select","Select",""],["","16729022701","SPIRONOLACT","TAB 100MG","60","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","68462018117","CLOTRIMAZOLE","CRE 0.01","45","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","69315012710","FOLIC","TAB 1000MCG","30","Select","Select",""],["","00093227434","AMOX\/K","TAB 500-125","20","Select","Select",""],["","00603533732","PREDNISONE","TAB 5MG","200","Select","Select",""],["","16714076501","VALGANCICLOV","TAB 450MG","30","Select","Select",""],["","65649030302","XIFAXAN","TAB 550MG","60","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","20","Select","Select",""],["","00904675180","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","57237000630","FLUCONAZOLE","TAB 200MG","7","Select","Select",""],["","00603020922","MAG","TAB 400MG","120","Select","Select",""],["","00781210201","TACROLIMUS","0.5 MG","120","Select","Select",""],["","16729009401","MYCOPHENOLAT","CAP 250MG","120","Select","Select",""],["","49348098023","SM","TAB 81MG EC","30","Select","Select",""],["","70748029901","ATOVAQUONE","SUS 750\/5ML","300","Select","Select",""],["","67877019890","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","-30","Select","Select",""],["","49483008001","SENNA-TIME","TAB 8.6MG","60","Select","Select",""],["","64980033912","MAGNESIUM-OX","TAB 400MG","120","Select","Select",""],["","00310111030","LOKELMA","10 G","30","Select","Select",""],["","16714076501","VALGANCICLOV TAB","450MG","30","Select","Select",""],["","70677013202","SM ASPIRIN TAB","81MG EC","30","Select","Select",""],["","70748029901","ATOVAQUONE SUS","750\/5ML","300","Select","Select",""],["","50742026001","NIFEDIPINE TAB","30MG ER","180","Select","Select",""],["","00310111030","LOKELMA PAK","10GM","30","Select","Select",""],["","00054472825","PREDNISONE TAB","5MG","60","Select","Select",""],["","00781210301","TACROLIMUS CAP","1MG","150","Select","Select",""],["","16714017401","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","00054016325","MYCOPHENOLATE MOFETIL","250 MG","60","Select","Select",""],["","00378363401","CARVEDILOL","25 MG","60","Select","Select",""],["","67877019890","AMLODIPINE TAB","5MG","30","Select","Select",""],["","21922001707","CLOBETASOL PROPIONATE","0.05 %","60","Select","Select",""],["","00378363401","CARVEDILOL TAB","25MG","60","Select","Select",""],["","00054016325","MYCOPHENOLAT CAP","250MG","60","Select","Select",""],["","70677013202","ASPIRIN EC","81 MG","30","Select","Select",""],["","16714017401","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","50742062001","NIFEDIPINE ER","30 MG","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":""}]}]}