{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AH ATINANOTGNIRR","gend":1,"add":"NIW 962TS NOTS","city":"RICHMOND","state":"VA","zip":23222,"dob":"1965-05-12","age":"","mstatus":"","insh":"0930210*22","cliId":"","pno":"14\/8769255-2","cno":"","email":"","ename":"","eno":"","pphy":"Abdel Shaheed, Samir","ppno":"804\/644-1665","pcpadd":"3925 Portsmouth Boulevard","pcpcity":"Chesapeake","pcpstate":"VA","pcpzip":23222,"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":["V54.12","Y99.0","M54.16","M54.32","M54.42","I10.","Z12.11","Z12.31","Z11.59","K59.00","M43.10","G89.29","Z68.28","Z20.5","R79.89","K21.9","J45.20","M46.1","J45.41","J30.9","V58.89","M77.42","S93.402A","S93.602A","S40.022A","W10.9XXA","M79.672","W10.8XXD","R27.9","M25.675","M62.81","R26.89","Z73.6","Z91.81","Z88.2","Z79.899","Z01.411","N39.0","M25.562","M25.462","L70.0","M77.12","M25.522","M54.5","M79.662","M25.572","S93.692A","M54.17","M62.838","E78.2","M54.41","Z68.27","M43.16","M54.9","E78.00","J45.909","H35.342","H52.03","H52.223","H52.4","R94.4","D50.9","K59.04","R10.30","D64.9","R73.03","N94.9","R10.2","R53.1","R73.09","E55.9","K59.03","L73.1","S10.86XA","L08.9","J06.0","J30.89","M70.52","E11.9","N76.0","D50.8","Z76.89","Z02.89","R35.0","L70.9","J45.901","J44.1","E87.2","E78.5","M79.606","Z20.822","Z87.891","R06.02","M72.2","J45.40","J45.21","M79.604","NO DATA","M79.671"],"date":["2019-05-13","2019-05-13","2019-06-05","2019-05-29","2020-03-10","2022-06-17","2019-06-05","2021-12-21","2019-06-05","2019-06-05","2019-06-05","2020-03-10","2021-12-21","2020-04-27","2020-04-27","2022-09-09","2020-06-29","2020-10-06","2022-04-29","2022-09-09","2021-12-22","2021-12-22","2021-10-09","2021-10-20","2021-10-09","2021-10-20","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2021-11-18","2022-06-17","2022-06-18","2020-01-09","2022-02-28","2020-01-20","2020-01-20","2021-12-21","2020-06-24","2020-06-24","2020-12-31","2020-12-31","2021-10-04","2021-11-17","2019-06-09","2019-08-27","2020-03-10","2019-12-23","2020-06-29","2019-05-21","2019-05-29","2019-06-09","2019-06-09","2019-07-11","2019-07-11","2019-07-11","2019-07-11","2019-12-09","2022-02-28","2020-06-29","2019-12-09","2020-02-25","2020-02-25","2019-11-11","2019-11-11","2020-06-12","2021-12-21","2021-12-21","2022-09-09","2021-12-21","2019-07-10","2019-07-10","2019-10-22","2020-06-29","2020-01-14","2022-04-29","2020-06-29","2019-06-19","2019-12-23","2019-12-23","2020-06-29","2022-04-29","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2022-09-09","2022-04-29","2022-06-17","2022-06-17","2022-09-09","2022-09-09"],"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":[["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","","FLUTICASONE"," FLUTICASONE ","16","Select","Select",""],["","72205001290","PREGABALIN","CAP 50MG","60","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","18","Select","Select",""],["","","PREDNISONE","PAK 10MG","","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","81131024071","SPACE","MIS ANTI-STA","1","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","90","Select","Select",""],["","45802012801","CLINDAMYCIN","LOT 0.01","60","Select","Select",""],["","00173071920","FLOVENT","AER 110MCG","12","Select","Select",""],["","57237004101","PENICILLN","TAB 500MG","28","Select","Select",""],["","49035048485","ACETAMINOPHN","TAB 500MG","20","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","90","Select","Select",""],["","00173071620","ADVAIR","AER 115\/21","12","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","3","Select","Select",""],["","","POLYETH"," POLYETH ","30","Select","Select",""],["","31604004070","D3","TAB 1000UNIT","90","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","","FERROUS","TAB 325MG","","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","","DOXYCYCLINE","TAB 50MG","","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","118","Select","Select",""],["","16714089902","FEXOFENADINE","TAB 180MG","90","Select","Select",""],["","65162010211","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","43538017260","CLINDACIN","MIS ETZ 1%","60","Select","Select",""],["","00781728750","CLINDAMY\/BEN","GEL 1-5%","50","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","","ALLERGY","TAB 180MG","","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","","ACID","TAB 20MG","","Select","Select",""],["","","DOXYCYC","TAB 50MG","","Select","Select",""],["","","BENZOYL","GEL 0.025","","Select","Select",""],["","","ALLEGRA","TAB 180MG","","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":""}]}]}