{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ALYAKRELTUC","gend":1,"add":"AO DLO 5571DAOR DNALK","city":"HENRICO","state":"VA","zip":"23231-9998","dob":"1996-12-18","age":"","mstatus":"","insh":"1591110*27","cliId":"","pno":"25\/4086888-8","cno":"","email":"","ename":"","eno":"","pphy":"ALLGOOD, SHERRY NP","ppno":"804\/226-2444","pcpadd":"4620 S LABURNUM AVE","pcpcity":"RICHMOND","pcpstate":"VA","pcpzip":23231,"pcpcounty":"","pcpid":"","pcpname":"LABURNUM MEDICAL CENTER ","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":["R10.11","R10.13","N39.0","J40.","M79.671","M79.672","Z30.42","Z32.02","H91.92","H90.12","R09.81","J34.3","Z20.822","J45.909","R05.","S40.012A","S70.02XA","S70.12XA","S80.02XA","R07.9","K21.9","J45.41","R05.9","R25.2","Z11.59","E55.9","M54.9","G47.00","G89.29","Z68.29","S50.02XA","M25.569","Z68.31","H65.93","J30.9","R20.0","R20.2","J06.9","M25.571","M25.572","R10.84","R10.2","R68.82","F17.200","R06.2","H66.003","J20.9","S93.402A","S80.12XA","W00.1XXA","B34.9","Z68.27","K59.00","H66.90","R50.9"],"date":["2020-01-05","2020-01-21","2020-01-05","2020-03-21","2021-05-04","2021-05-04","2021-10-29","2020-05-15","2021-06-18","2021-06-18","2021-09-21","2021-06-18","2021-09-21","2021-09-27","2021-09-21","2021-09-27","2021-09-27","2021-09-27","2021-09-27","2021-11-18","2021-11-17","2021-11-17","2021-11-18","2021-11-17","2021-11-17","2021-11-17","2021-05-04","2021-05-04","2021-05-04","2020-01-21","2021-09-27","2021-09-27","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-04","2021-05-26","2020-08-12","2020-08-12","2020-11-12","2020-11-12","2020-11-12","2020-03-21","2021-11-18","2019-03-27","2019-03-27","2019-01-05","2019-01-05","2019-01-05","2019-02-06","2019-08-30","2019-05-30","2019-05-30","2019-11-20"],"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":[["","","ALBUTEROL"," ALBUTEROL ","8","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","","AMITRIPTYLIN"," AMITRIPTYLIN ","30","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","40","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","HYDROXYZ"," HYDROXYZ ","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","","SERTRALINE"," SERTRALINE ","45","Select","Select",""],["","","PREDNISONE"," PREDNISONE ","28","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","75","Select","Select",""],["","59779035926","TUSSIN","LIQ 10-100\/5","118","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","","CVS"," CVS ","476","Select","Select",""],["","70436001004","BUPROPN","TAB 150MG XL","90","Select","Select",""],["","","NAPROXEN"," NAPROXEN ","60","Select","Select",""],["","","OMEPRAZOLE","CAP 20MG","","Select","Select",""],["","","BENZONATATE"," BENZONATATE ","15","Select","Select",""],["","","ONDANSETRON"," ONDANSETRON ","15","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","","MONTELUKAST"," MONTELUKAST ","30","Select","Select",""],["","","CHANTIX"," CHANTIX ","60","Select","Select",""],["","","MEDROXYPR"," MEDROXYPR ","1","Select","Select",""],["","","ERYTHROMYCIN"," ERYTHROMYCIN ","4","Select","Select",""],["","","CETIRIZINE"," CETIRIZINE ","30","Select","Select",""],["","","CLINDAMYCIN"," CLINDAMYCIN ","30","Select","Select",""],["","","SMZ\/TMP"," SMZ\/TMP ","14","Select","Select",""],["","","COLD"," COLD ","118","Select","Select",""],["","","FAMOTIDINE"," FAMOTIDINE ","60","Select","Select",""],["","","DOXYCYCL"," DOXYCYCL ","14","Select","Select",""],["","","BROM\/PSE\/DM"," BROM\/PSE\/DM ","200","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","30","Select","Select",""],["","","MELATONIN"," MELATONIN ","30","Select","Select",""],["","","METHYLPRED"," METHYLPRED ","21","Select","Select",""],["","","SYMBICORT"," SYMBICORT ","10","Select","Select",""],["","","AZITHROMYCIN"," AZITHROMYCIN ","6","Select","Select",""],["","","GABAPENTIN","CAP 100MG","","Select","Select",""],["","","BUDES\/FORMOT","AER 80-4.5","","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","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":""}]}]}