{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A   ADNOHRALNOSDRAHCIR ","gend":1,"add":"S EINNEJ 8051G TPA DR REHC","city":"HENRICO","state":"VA","zip":"23231-9998","dob":"1988-06-04","age":"","mstatus":"","insh":"0031210*96","cliId":"","pno":"58\/4087527-2","cno":"","email":"","ename":"","eno":"","pphy":"ELLIOTT, CHARMAINE N MD","ppno":"804\/644-1665","pcpadd":"SUITE 308 1510 N 28TH STREET","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23223,"pcpcounty":"","pcpid":"","pcpname":"PRIMARY HEALTHCARE 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":["J10.1","R35.0","R10.9","F11.20","G50.0","J44.9","F17.210","Z68.24","K12.2","H92.02","F31.9","F20.9","M26.622","Z68.29","Z01.411","Z11.51","Z80.3","Z72.0","Z33.1","Z91.19","F33.9","F12.20","F25.1","Z20.2","N89.8","N92.6","R07.89","R05.","R06.02","N64.52","Z68.25","F11.24","Z01.419","J30.9","J32.9","R00.1","R07.9","I49.9","J11.1","Z98.890","Z87.891","F39.","Z87.19","A41.9","R06.00","J06.9","K43.9","M65.4","J44.1"],"date":["2020-02-14","2020-02-14","2020-02-14","2021-04-01","2020-12-09","2021-12-15","2021-08-09","2020-01-17","2020-06-14","2020-12-02","2021-12-15","2021-12-15","2020-12-02","2020-12-02","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-05-03","2021-12-15","2020-09-23","2021-02-10","2020-10-01","2020-10-03","2020-10-03","2020-03-13","2020-03-13","2021-08-09","2021-08-09","2020-03-13","2020-03-13","2020-09-10","2021-05-03","2021-08-09","2021-08-09","2020-12-09","2019-12-10","2019-04-20","2019-04-20","2019-05-23","2019-05-23","2019-05-23","2019-05-23","2019-03-01","2019-05-12","2019-05-12","2019-05-23","2019-07-08","2019-04-06"],"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":[["","","IBUPROFEN"," IBUPROFEN ","20","Select","Select",""],["","59779044574","CVS","DIS 14MG\/24H","30","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","","MONTELUKAST"," MONTELUKAST ","30","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","75","Select","Select",""],["","","SYMBICORT"," SYMBICORT ","10","Select","Select",""],["","","ARIPIPRAZOLE","TAB 2MG","","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","69842000101","BUDESONIDE","SUS 32MCG","8","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","73796045801","COMP","MIS COMP\/NEB","1","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","","PROVENTIL"," PROVENTIL ","7","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","12","Select","Select",""],["","","ACETAMIN"," ACETAMIN ","20","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","","DICLOFENAC"," DICLOFENAC ","60","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","","MUCINEX"," MUCINEX ","60","Select","Select",""],["","","OXYCOD\/APAP"," OXYCOD\/APAP ","12","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","ALLERGY","TAB 4MG","","Select","Select",""],["","","PROMETHAZINE","SYP 6.25\/5ML","","Select","Select",""],["","","MUCUS","TAB 600MG ER","","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","PENICILLN","TAB 500MG","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","AFLURIA","INJ 2020-21","","Select","Select",""],["","","XOFLUZA","TAB 40MG","","Select","Select",""],["","","NICOTINE","DIS 21MG\/24H","","Select","Select",""],["","","BENZONATATE","CAP 200MG","","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","","GABAPENTIN","CAP 300MG","","Select","Select",""],["","","DIAZEPAM","TAB 5MG","","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":""}]}]}