{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" REFINNEJSENOJ R  ","gend":1,"add":"TNOMLE 130212012 TPA DR ","city":"ASHLAND","state":"VA","zip":"23005-9998","dob":"1973-06-04","age":"","mstatus":"","insh":"0436110*34","cliId":"","pno":"19\/4081193-2","cno":"804\/912-3911","email":"","ename":"","eno":"","pphy":"GALICHON, KAREN MD","ppno":"804\/217-9091","pcpadd":"12018 WEST BROAD STREET STE 101","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23233,"pcpcounty":"","pcpid":"","pcpname":"Primary Health Group - Short Pump","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G24.5","G24.4","R11.2","K59.00","R10.31","K92.1","K63.5","Z20.828","R06.02","R50.9","R07.0","M54.16","M54.5","M25.552","Z76.89","F90.8","J30.89","Z51.81","E66.3","F41.9","F43.21","NO DATA","B00.9","N39.3","F41.1","F90.0","F10.21","Z86.19","N12.","W57.XXXA","H40.013","H25.13","M65.9","F90.9","R53.83","R76.8","R35.0","J45.20","M50.20","N89.8","Z13.220","Z68.24","F41.8","R41.840","G89.29","N30.00","R74.8","J45.40","M21.611","L03.011","L08.89","M79.644","N81.5","R32.","R15.9","N81.10","N81.6","N99.3","U07.1","K62.5","D12.3","K64.1","Z00.01","Z11.4","Z11.8","S99.922A","G24.8","F45.8","R48.2","E83.42","R07.89","B34.9","M10.9","K65.9","B37.7","R74.01","E83.51","Z68.26","M25.561","N76.0","J45.909","M26.622","F10.11","A69.20","J35.8","M54.9","M54.2","R05.","J02.9","R09.81","K62.3","J40.","Z11.59","Z03.818","S73.192A","N95.1","Z80.41","Z91.89","R14.0","M70.40","M79.89"],"date":["2021-04-08","2022-08-09","2021-05-06","2020-10-26","2020-10-26","2020-11-13","2020-11-13","2021-09-25","2020-05-20","2020-05-20","2020-05-20","2020-12-29","2021-05-06","2021-09-03","2021-01-07","2022-08-09","2022-05-20","2022-08-09","2022-05-20","2022-08-09","2022-08-09","2021-09-03","2022-08-09","2020-08-24","2020-12-08","2020-12-08","2020-12-08","2020-12-08","2021-05-06","2021-05-06","2022-06-13","2022-06-13","2022-08-11","2020-07-27","2020-07-27","2020-01-15","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-07-27","2020-10-01","2020-10-01","2021-06-03","2021-06-03","2021-06-03","2021-06-03","2022-05-20","2022-08-15","2022-08-30","2022-08-30","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-09-12","2020-11-13","2020-11-13","2020-11-13","2021-03-08","2021-03-08","2021-03-08","2021-09-03","2020-05-13","2020-05-13","2020-05-13","2020-11-06","2020-09-02","2021-09-25","2022-08-15","2020-03-30","2020-03-30","2020-11-06","2020-11-06","2020-11-06","2022-07-20","2022-08-09","2022-08-15","2021-07-07","2021-07-07","2022-08-11","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-03-17","2020-08-12","2020-09-08","2020-09-18","2020-09-18","2021-03-16","2021-09-16","2021-09-16","2021-09-16","2021-09-16","2022-07-19","2022-08-12"],"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":[["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","00555088602","ESTRADIOL","TAB 1MG","60","Select","Select",""],["","17478071610","APRACLONIDIN","SOL 0.5% OP","5","Select","Select",""],["","00378427677","VALACYCLOVIR","TAB 1GM","30","Select","Select",""],["","69097015915","MELOXICAM","TAB 15MG","90","Select","Select",""],["","00527150537","AMPHET\/DEXTR","TAB 20MG","60","Select","Select",""],["","65162022808","LYLLANA","DIS 0.1MG","8","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","65862008501","CEFADROXIL","CAP 500MG","40","Select","Select",""],["","43598049501","NAPROXEN","TAB 550MG","10","Select","Select",""],["","00069034530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","27","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","15","Select","Select",""],["","70010000201","COLCHICINE","TAB 0.6MG","20","Select","Select",""],["","49281042250","FLUZONE","INJ 2022-23","0","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","65862007601","CIPROFLOXACN","TAB 250MG","10","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","00591079401","DICYCLOMINE","CAP 10MG","90","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59651036105","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","9","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","60432003816","GENERLAC","SOL 10GM\/15","1260","Select","Select",""],["","00527133001","BACLOFEN","TAB 10MG","21","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","1260","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","40","Select","Select",""],["","00363023840","STOOL","CAP 100MG","60","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","60","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","11917013938","VITAMIN","TAB 500MG","20","Select","Select",""],["","65862064169","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68585000801","ZINC","CAP 220MG","10","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","11523723404","MIRALAX","POW 3350 NF","510","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0","Select","Select",""],["","65649041112","ANUSOL-HC","SUP 25MG","15","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","00363091530","OMEPRAZOLE","TAB 20MG","30","Select","Select",""],["","00713050324","ANUCORT-HC","SUP 25MG","28","Select","Select",""],["","64380076621","PEG-3350","SOL ELECTROL","4000","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":""}]}]}