{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  AITITELTTOCS N ","gend":1,"add":"CRIBYERG 5537 TINU RD H","city":"RICHMOND","state":"VA","zip":"23225-9998","dob":"1992-04-14","age":"","mstatus":"","insh":"1278710*49","cliId":"","pno":"62\/4087957-3","cno":"","email":"","ename":"","eno":"","pphy":"AKBAR, SALMAN MD","ppno":"804\/330-5452","pcpadd":"909 HIOAKS RD STE F\/G","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23225,"pcpcounty":"","pcpid":"","pcpname":"SALMAN M AKBAR MD","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":["J45.901","S49.91XA","S41.112A","F11.20","S16.1XXA","S29.019A","S39.012A","S63.502A","D64.9","V49.40XA","M54.2","J45.40","F17.290","Z79.899","R06.02","N30.01","N76.0","J06.9","J45.909","G89.4","I10.","L30.9","R21.","T78.40XA"],"date":["2020-03-12","2021-12-29","2021-12-29","2019-01-25","2019-04-07","2019-04-07","2019-04-07","2019-04-07","2019-04-07","2019-04-07","2019-04-09","2019-07-28","2019-07-28","2019-07-28","2019-07-28","2019-01-21","2019-01-21","2019-12-26","2022-02-04","2022-02-04","2022-02-04","2022-11-01","2022-11-01","2022-11-01"],"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":[["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","60505025203","TIZANIDINE","TAB 4MG","30","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","70954044410","MISOPROSTOL","TAB 200MCG","8","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","42571038519","TRIAMCINOLON","LOT 0.001","60","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","LEVOCETIRIZI","TAB 5MG","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","70010075405","METHOCARBAM","TAB 500MG","15","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","40","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","20","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","40","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","15","Select","Select",""],["","59746017710","CYCLOBENZAPR","TAB 10MG","40","Select","Select",""],["","60432060616","PROMETH\/COD","SOL 6.25-10","180","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","15","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","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":""}]}]}