{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   EILSELYELTRAB A","gend":1,"add":"A REPPU 7211TS XOTTAMOPP","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1974-12-13","age":"","mstatus":"","insh":"00400210*26","cliId":"","pno":"52\/4084783-5","cno":"","email":"","ename":"","eno":"","pphy":"JIN, XIAO HONG MD","ppno":"804\/732-0648","pcpadd":"15 GOODRICH AVE","pcpcity":"PETERSBURG","pcpstate":"VA","pcpzip":23805,"pcpcounty":"","pcpid":"","pcpname":"XIAO HONG JIN MD PLLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","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":["Z23.","B20.","K21.9","J45.909","Z79.899","J06.9","J01.00","J30.89","M62.830","M79.672","R60.9","F17.200","J30.9","NO DATA","J02.9","Z20.828","M54.5","E55.9","R05.","Z01.419","Z90.710","K59.00","L83.","L70.0","L81.0","Z00.00","Z91.018","H61.22","M79.671","M79.604","M79.605","Z86.19","M17.11","M25.572","F17.210","R22.42","Z87.828","M25.472","Z71.2","I10.","A60.9","I83.812","I83.91","Z91.013","N95.1"],"date":["2021-11-16","2022-05-09","2021-05-18","2022-06-21","2021-11-16","2020-02-14","2020-02-14","2022-11-22","2020-01-24","2021-12-29","2021-12-29","2021-12-29","2022-01-10","2020-07-27","2022-01-10","2020-07-27","2021-05-18","2021-11-16","2020-10-16","2022-03-15","2020-01-06","2020-01-06","2021-08-05","2021-08-05","2021-08-05","2021-08-31","2021-08-24","2021-08-24","2021-08-31","2021-08-31","2019-06-21","2019-07-09","2019-10-16","2022-08-18","2019-05-09","2022-08-18","2022-08-18","2022-08-18","2022-04-08","2022-04-08","2022-05-09","2022-04-15","2022-04-15","2022-04-15","2022-03-15"],"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":[["","","GENVOYA"," GENVOYA ","30","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","","PREZISTA"," PREZISTA ","30","Select","Select",""],["","","PROMETHAZINE","SYP DM","","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","","FAMOTIDINE"," FAMOTIDINE ","90","Select","Select",""],["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","","CETIRIZINE","TAB 10MG","","Select","Select",""],["","69618001001","ACETAMIN","TAB 325MG","40","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","63824077016","CEPACOL","LOZ 15-20MG","16","Select","Select",""],["","45802016000","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","16729022716","SPIRONOLACT","TAB 100MG","30","Select","Select",""],["","31722070590","VALACYCLOVIR","TAB 1GM","14","Select","Select",""],["","61314030802","AZELASTINE","DRO 0.0005","6","Select","Select",""],["","16729017317","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","LORATADINE","TAB 10MG","","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0","Select","Select",""],["","16729011917","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","46122006271","8","TAB 650MG","60","Select","Select",""],["","00168020437","LIDOCAINE","OIN 0.05","35","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","33332032001","AFLURIA","INJ 2020-21","0","Select","Select",""],["","52817033050","CYCLOBENZAPR","TAB 5MG","40","Select","Select",""],["","00187516245","RETIN-A","CRE 0.0005","45","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","51672139409","TRETINOIN","CRE 0.0005","45","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","49502050002","EPIPEN","INJ 0.3MG","2","Select","Select",""],["","50228014605","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","","GAVILAX","POW ","","Select","Select",""],["","","BROM\/PSE\/DM","SYP ","","Select","Select",""],["","50111078810","AZITHROMYCIN","TAB 500MG","5","Select","Select",""],["","60842002301","AUVI-Q","INJ 0.3MG","2","Select","Select",""],["","","VIRTUSSIN","SOL 100-10\/5","","Select","Select",""],["","","ACETAMINOPHE","TAB 325MG","","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":""}]}]}