{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AH ATINANOTGNIRR","gend":1,"add":"NIW 962TS NOTS","city":"RICHMOND","state":"VA","zip":"23222-9998","dob":"1965-05-12","age":"","mstatus":"","insh":"0930210*22","cliId":"","pno":"14\/8769255-2","cno":"678\/412-5529","email":"","ename":"","eno":"","pphy":"RILES JR, NATHAN L MD","ppno":"757\/424-4442","pcpadd":"6632 INDIAN RIVER RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23464,"pcpcounty":"","pcpid":122066,"pcpname":"Nowcare Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","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":["R79.89","M54.42","D64.9","R73.03","G89.29","Z68.28","E11.9","I10.","E78.2","M25.522","R53.1","M79.662","M46.1","M77.12","M54.5","Z01.411","N39.0","R35.0","J45.20","K21.9","D50.9","J30.89","J30.9","K59.04","Z12.31","L70.9","N76.0","Z68.27","L70.0","J45.41","M25.562","M25.462","M70.52","Z20.5"],"date":["2020-04-27","2020-03-10","2020-02-25","2020-02-25","2020-03-10","2020-03-10","2020-06-29","2020-04-27","2020-03-10","2020-06-24","2020-06-12","2020-12-31","2020-10-06","2020-06-24","2020-12-31","2020-01-09","2020-01-09","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2021-08-02","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2020-06-29","2021-05-17","2021-08-02","2020-01-20","2020-01-20","2020-01-14","2020-04-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00904759080","FEROSUL ","325MG","60","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","68645048054","ATORVASTATIN ","10MG","30","Select","Select",""],["","51293081101","PHENAZOPYRID ","200MG","6","Select","Select",""],["","69097084507","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","31604003175","","","60","Select","Select",""],["","00603533815","PREDNISONE ","10MG","21","Select","Select",""],["","57896070310","IRON ","325MG","60","Select","Select",""],["","16714081901","OSELTAMIVIR ","75MG","10","Select","Select",""],["","68645055254","LISINOPRIL ","10MG","30","Select","Select",""],["","49035057139","ALLERGY ","180MG","30","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","61314012605","KETOROLAC ","0.50%","10","Select","Select",""],["","70710112101","DOXYCYCLINE ","50MG","90","Select","Select",""],["","11523726803","MIRALAX ","3350 NF","30","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","20","Select","Select",""],["","60758011905","PREDNISOLONE ","1% OP","15","Select","Select",""],["","45802086866","POLYETH ","3350 NF","30","Select","Select",""],["","45802010196","BENZOYL ","2.50%","60","Select","Select",""],["","49035065071","ACID ","20MG","60","Select","Select",""],["","00904759180","FERROUS ","325MG","60","Select","Select",""],["","66993001968","ALBUTEROL ","HFA","18","Select","Select",""],["","59762374401","CLINDAMYCIN ","10MG\/ML","60","Select","Select",""],["","23155013301","DOXYCYC ","50MG","90","Select","Select",""],["","60432060416","PROMETHAZINE ","DM","118","Select","Select",""],["","41167412004","ALLEGRA ","180MG","90","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","16714089902","FEXOFENADINE ","180MG","90","Select","Select",""],["","68645056354","IBUPROFEN ","800MG","20","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","21","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","51293081101","PHENAZOPYRID","200MG","6","Select","Select",""],["","69097084507","CYCLOBENZAPR","5MG","30","Select","Select",""],["","00904759080","FEROSUL","325MG","60","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","68645048054","ATORVASTATIN","10MG","30","Select","Select",""],["","68645055254","LISINOPRIL","10MG","30","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","49035057139","ALLERGY","180MG","30","Select","Select",""],["","57896070310","IRON","325MG","60","Select","Select",""],["","61314012605","KETOROLAC","0.50%","10","Select","Select",""],["","70710112101","DOXYCYCLINE","50MG","90","Select","Select",""],["","11523726803","MIRALAX","3350 NF","30","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","20","Select","Select",""],["","00904759180","FERROUS","325MG","60","Select","Select",""],["","45802010196","BENZOYL","2.50%","60","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","49035065071","ACID","20MG","60","Select","Select",""],["","23155013301","DOXYCYC","50MG","90","Select","Select",""],["","45802086866","POLYETH","3350 NF","56","Select","Select",""],["","41167412004","ALLEGRA","180MG","90","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","68645056354","IBUPROFEN","800MG","20","Select","Select",""],["","80777027399","MODERNA","COVID-19","0","Select","Select",""],["","59762374401","CLINDAMYCIN","10MG\/ML","60","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","21","Select","Select",""],["","60432060416","PROMETHAZINE","DM","118","Select","Select",""],["","00173071920","FLOVENT","110MCG","12","Select","Select",""],["","55111078401","FEXOFENADINE","180MG","90","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","16714081901","OSELTAMIVIR","75MG","10","Select","Select",""],["","60758011905","PREDNISOLONE","1% OP","15","Select","Select",""],["","00173071920","FLOVENT ","AER 110MCG","12","Select","Select",""],["","43538017260","CLINDACIN ","MIS ETZ 1%","60","Select","Select",""],["","65162010211","GABAPENTIN ","CAP 300MG","60","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}