{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ACINWADNOTROH L ","gend":1,"add":"LB 6271TS RIA","city":"RICHMOND","state":"VA","zip":"23220-9998","dob":"1997-07-07","age":"","mstatus":"","insh":"09400210*25","cliId":"","pno":"19\/4086134-8","cno":"","email":"","ename":"","eno":"","pphy":"BELLE, CHERYL M MD","ppno":"804\/325-8801","pcpadd":"STE 200 2401 W LEIGH ST","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23220,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS SPORTS MEDICINE & PRIMARY CARE","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":["F33.2","F31.5","F31.32","F60.3","F43.12","F33.1","F25.0","O09.93","O99.343","F31.9","F90.9","F20.9","N13.30","O34.211","O35.8XX0","Z3A.31","O32.1XX0","O69.2XX0","O99.344","F41.9","O99.214","Z37.0","Z3A.39","Z20.822","Z62.810","Z87.891","Z88.0","Z30.2","F39.","F31.81","F99.","M67.431","N76.0","E66.01","B37.3","M25.511","B96.89","Z68.35","F43.10","V23.89","O99.342","O99.512","O99.332","F17.210","Z3A.21","O99.891","O99.513","J45.909","Z3A.35","Z3A.36","O47.1","F31.30","N93.9","Z13.220","M67.432","Z12.4","Z68.31","J03.80","Z00.00","R10.2","N89.8","N30.90","J45.20","J06.9","Z30.42","M67.40","Z13.228","Z13.29","F90.2","M79.641","M67.439","Z33.1","O32.1XX1","Z3A.37","F20.0","O99.345","F32.9","U07.1","Z03.818","R52.","Y04.0XXA","H92.02","H91.92","Z68.32","O26.891","R10.9","Z3A.01","V23.5","Z3A.25"],"date":["2021-02-22","2021-11-16","2021-07-04","2021-12-27","2021-09-20","2021-05-17","2020-12-23","2021-06-23","2021-08-12","2021-08-16","2021-08-12","2021-09-30","2021-07-15","2021-08-16","2021-08-12","2021-06-23","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-11-30","2021-08-16","2021-08-16","2021-08-16","2021-08-16","2021-08-31","2021-12-26","2021-12-29","2019-09-19","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2019-03-20","2021-08-12","2021-05-06","2021-04-08","2021-04-08","2021-04-08","2021-04-08","2021-07-15","2021-08-04","2021-08-04","2021-07-15","2021-07-28","2021-08-12","2021-11-07","2019-08-07","2019-08-07","2019-08-07","2021-11-16","2019-08-07","2020-12-03","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2021-11-16","2020-02-20","2019-06-10","2019-06-10","2019-06-10","2019-06-10","2020-12-23","2019-08-27","2019-08-27","2021-07-21","2021-08-04","2021-08-04","2021-04-19","2021-09-30","2021-09-30","2021-11-30","2021-11-30","2019-01-03","2019-01-03","2019-09-04","2019-09-04","2019-09-04","2020-12-30","2020-12-30","2020-12-30","2021-05-06","2021-05-06"],"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 ","30","Select","Select",""],["","","SERTRALINE"," SERTRALINE ","30","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","14","Select","Select",""],["","","LAMOTRIGINE"," LAMOTRIGINE ","42","Select","Select",""],["","","TRAZODONE"," TRAZODONE ","30","Select","Select",""],["","","MEDROXYPR"," MEDROXYPR ","1","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","","MICONAZOLE"," MICONAZOLE ","45","Select","Select",""],["","","OXYCODONE"," OXYCODONE ","30","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","","HYDROXYZ","CAP 25MG","","Select","Select",""],["","","FLUOXETINE","CAP 20MG","","Select","Select",""],["","","BENZONATATE","CAP 200MG","","Select","Select",""],["","","PRENATAL","CAP 200MG","","Select","Select",""],["","","LITHIUM","TAB 300MG ER","","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","","DIVALPROEX","TAB 250MG DR","","Select","Select",""],["","","QUETIAPINE","TAB 50MG","","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","NEO\/POLY\/HC","SUS 1% OTIC","","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":""}]}]}