{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" HTEBAZILENOTLUF F ","gend":1,"add":" KRAP 1285202 # EVA","city":"RICHMOND","state":"VA","zip":"23226-9998","dob":"1988-04-18","age":"","mstatus":"","insh":"1549110*46","cliId":"","pno":"4640872177","cno":"","email":"","ename":"","eno":"","pphy":"SHABAN, DANNY MD","ppno":8047300800,"pcpadd":"STE A 8239 MEADOWBRIDGE RD","pcpcity":"MECHANICSVILLE","pcpstate":"VA","pcpzip":"23116-9998","pcpcounty":"","pcpid":"","pcpname":"Dominion Women's Health","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":["E03.8","E05.90","Z12.31","N63.11","N63.15","C50.911","T78.40XA","C50.111","C77.3","Z17.1","R53.83","C50.411","Z86.39","Z51.89","Z51.11","E06.3","C50.919","L64.0","Z51.12","C32.0","M50.20","E34.8","C50.811","Z17.0","M79.622","R21.","G62.0","Z79.899","C79.51","C80.1","M89.8X5","C50.812","R91.1","Z90.11","R10.9","M89.9","U07.1","D70.9","D69.6","D62.","D22.4","L27.0","L70.0","T86.820","E86.0","K12.31","I42.7","I36.1","I37.1","Z68.22","R20.0","E04.9","R92.8","N64.59","C50.511","D61.810","R50.81","D35.4","M79.602","M47.812","M50.222","I95.9","Z85.3","C50.611","R59.9","F41.9","Z48.3","I97.2","M25.611","Z01.810","G89.3","Z51.81","Z68.21","Z51.0","M89.251","M89.252","C50.912","N63.10","D69.59","F41.8","Z92.21","Z98.890","Z79.01","Z79.891","R50.9","D70.8","N64.9","Z90.12","Z01.89","I08.1","M84.851","Z01.411","Z11.51","K76.89","R05.9","R59.0","L59.8","I07.1","T45.1X5A","M25.551","Z92.3","Z04.9","Z01.419"],"date":["2022-08-10","2022-12-06","2021-08-27","2021-08-27","2021-08-27","2023-05-17","2021-09-10","2022-12-06","2023-02-20","2023-07-25","2022-08-10","2023-01-31","2023-01-26","2023-01-05","2023-04-17","2023-01-05","2023-04-11","2023-01-05","2021-11-05","2022-01-10","2022-02-02","2022-02-02","2022-03-18","2023-01-23","2023-07-25","2023-01-05","2023-01-05","2023-05-30","2023-06-21","2023-02-02","2023-03-17","2023-07-25","2023-01-31","2023-01-31","2023-03-07","2023-03-15","2022-01-03","2022-01-03","2022-01-03","2022-01-03","2022-01-18","2022-01-18","2022-01-18","2022-03-31","2022-10-17","2022-12-05","2023-02-06","2023-02-06","2023-02-06","2023-04-17","2023-03-06","2021-05-13","2022-03-18","2021-09-07","2021-12-06","2022-01-03","2022-01-03","2022-02-02","2022-06-20","2022-02-02","2022-02-02","2022-08-10","2023-01-26","2022-03-21","2022-03-21","2022-03-21","2022-08-08","2022-08-08","2022-08-08","2022-08-08","2023-01-24","2023-05-30","2023-02-08","2022-06-01","2023-02-10","2023-02-10","2023-03-17","2021-08-27","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2021-12-31","2022-01-02","2021-12-28","2022-04-18","2022-05-06","2022-11-30","2023-01-16","2021-05-28","2022-06-10","2021-09-08","2021-12-31","2021-12-31","2022-06-08","2023-02-06","2022-12-06","2023-01-13","2023-02-02","2023-02-10","2022-06-10"],"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":[["","00430042014","LO","TAB 40452","84","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","51991070401","ALPRAZOLAM","TAB 0.25MG","30","Select","Select",""],["","69238183207","LEVOTHYROXIN","TAB 75MCG","90","Select","Select",""],["","60793085601","LEVOXYL","TAB 125MCG","45","Select","Select",""],["","51293082001","METHIMAZOLE","TAB 5MG","60","Select","Select",""],["","55111046605","METOPROL","TAB 25MG ER","120","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68382052860","CHOLESTYRAM","POW 4GM","30","Select","Select",""],["","68180051202","LISINOPRIL","TAB 2.5MG","30","Select","Select",""],["","70700011585","SYEDA","TAB 3-0.03MG","28","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00904699860","DOCUSATE","CAP 100MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","15","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","30","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","6","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","65862021150","MINOCYCLINE","CAP 100MG","20","Select","Select",""],["","27808003501","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","40","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","65862007850","CIPROFLOXACN TAB","750MG","14","Select","Select",""],["","51991070401","ALPRAZOLAM TAB","0.25MG","30","Select","Select",""],["","51672140004","CLINDAMYCIN LOT","1%","60","Select","Select",""],["","68462015713","ONDANSETRON TAB","4MG ODT","30","Select","Select",""],["","47781030301","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","00093342505","LORAZEPAM","0.5 MG","30","Select","Select",""],["","00054418425","DEXAMETHASON TAB","4MG","6","Select","Select",""],["","59746011506","PROCHLORPER TAB","10MG","30","Select","Select",""],["","00904699860","DOCUSATE SOD CAP","100MG","30","Select","Select",""],["","65162004710","OXYCODONE TAB","5MG","12","Select","Select",""],["","51224011960","GABAPENTIN CAP","300MG","30","Select","Select",""],["","72205000792","CAPECITABINE TAB","500MG","84","Select","Select",""],["","00093342505","LORAZEPAM TAB","0.5MG","30","Select","Select",""],["","24208091055","ERYTHROMYCIN OIN","5MG\/GM","4","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","5","Select","Select",""],["","55111046705","METOPROL SUC TAB","50MG ER","90","Select","Select",""],["","00781717612","NALOXONE HCL","4 MG","2","Select","Select",""],["","00591544221","PREDNISONE","10 MG","21","Select","Select",""],["","00168035730","LIDOCAINE-PRILOCAINE","2.5 %-2.5%","30","Select","Select",""],["","59651030030","TAMOXIFEN CITRATE","20 MG","90","Select","Select",""],["","59746011506","PROCHLORPERAZINE MALEATE","10 MG","50","Select","Select",""],["","57237007630","ONDANSETRON HCL","8 MG","60","Select","Select",""],["","55111046705","METOPROLOL SUCCINATE","50 MG","90","Select","Select",""],["","55111016330","OLANZAPINE","2.5 MG","30","Select","Select",""],["","00406114201","METHYLPHENIDATE HCL","5 MG","30","Select","Select",""],["","42571016242","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","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":""}]}]}