{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"A YNOBENOSREDN","gend":1,"add":" REVIR 96802DAOR ECARRET","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1986-11-15","age":"","mstatus":"","insh":"0918710*12","cliId":"","pno":"32\/8797746-5","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":"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":["Z01.419","A59.01","Z32.02","E66.01","I10.","Z30.011","Z68.43","Z30.09","Z11.3","R03.0","J45.909","Z20.828","R07.9","Z74.3","M75.41","M25.511","M79.605","V58.89","R10.9","F33.2","S80.12XA","W01.0XXA","J06.9","Z20.822","E11.9","R19.7","R94.31","F17.200","R05.9","N83.201","N83.202","R06.4","R10.33","R60.0","F33.8","M79.662","I73.9","M17.11","R79.1","M25.561","N92.0","R52.","M25.461","M11.861"],"date":["2021-03-05","2021-03-05","2022-10-07","2022-10-07","2021-11-28","2021-03-05","2022-10-07","2021-04-09","2021-04-09","2021-04-09","2021-11-28","2021-09-27","2021-11-28","2021-11-28","2020-10-21","2020-10-21","2021-01-05","2021-01-05","2020-03-04","2020-09-19","2020-12-27","2020-12-27","2021-11-28","2021-11-28","2021-11-28","2021-11-28","2021-11-28","2021-11-28","2021-11-28","2020-03-04","2020-03-04","2021-01-23","2020-02-21","2021-01-25","2021-01-25","2021-01-25","2021-01-25","2022-09-15","2022-09-15","2022-09-15","2022-10-07","2022-09-15","2022-09-15","2022-09-15"],"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":[["","64380015901","MEGESTROL","TAB 40MG","10","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","30","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","15","Select","Select",""],["","68382097001","CHLORTHALID","TAB 25MG","90","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","13","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","62559026530","TRANEX","TAB 650MG","30","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","7","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00536589688","NICOTINE","DIS 21MG\/24H","30","Select","Select",""],["","71093014105","METHOCARBAM","TAB 750MG","40","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","59779060006","CVS","TAB 81MG EC","90","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","90","Select","Select",""],["","68462030529","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","70436000101","POT  CHLORIDE","TAB 8MEQ ER","90","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00642747001","SLYND","TAB 4MG","84","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","69842081926","CVSTUSSIN","LIQ 20-400MG","200","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59310057922","PROAIR","AER ","17","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","IBUPROFEN","TAB 600MG","","Select","Select",""],["","","TRAMADOL","TAB 50MG","","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":""}]}]}